Spleen preserving distal pancreatectomy in a situs inversus totalis patient

Abstract

Purpose: Solid pseudopapillary tumor (SPT) of the pancreas is an uncommon neoplasm with a low malignant potential that generally occurs in young women. Surgical resection is the gold standard treatment for this entity. When possible, laparoscopic resection is advisable. We present the case of a 26 years old patient with situs inversus totalis diagnosed with a SPT located in the tail of the pancreas. Methods: A 25-year-old woman presented after being study for renal pain and incidentally finding a distal pancreatic mass. CT-Scan showed a rounded hypodense mass of 25 mm located in the tail of the pancreas and a situs inversus totalis. None laboratory alteration was founded. Histology by USE confirmed the presence of a solid pseudopapillary tumor. A laparoscopic distal spleen preserving pancreatectomy was proposed. Results: The usual trocar position was changed like a mirror and the surgeon was located between the patient's legs. The first visualization showed a complete inverted position of all abdominal organs. An extra 5 mm trocar was used to remove the gallbladder due to stones and recurrent upper right quadrant pain. The cystic duct and artery had to be dissected with the left hand to be able to dissect from medial to lateral. Completion of cholecystectomy did not present any extra complexity. After opening the lesser omentum, an intraoperative ultrasonography of the pancreas was performed that showed a hypoechogenic mass on the tail of the pancreas located on the right of the patient. The splenic artery and vein were dissected and were also in a mirror position. The dissection of the superior border of the pancreas, as well as the splenic artery, resulted easy as the right hand was straightforward while splenic vein dissection that was very encircled in the posterior face of the pancreas resulted in an increased difficulty. After the division of these vessels and the neck of the pancreas, spleen preserving distal pancreas were completed as usual. The patient was discharged on the 5 th postoperative day with drainage after a biochemical pancreatic leakage. Conclusion: Despite technical difficulties when operating situs inversus totalis patients, laparoscopic spleen preserving pancreatectomy is a safe and feasible technique.