Subtotal Stomach Preserving Pancreaticoduodenectomy for a 14-Year-Old Boy with Benign Duodenal Stenosis

Abstract

Background: Subtotal stomach preserving pancreaticoduodenectomy (SSpPD) is one of the highly invasive surgery and rarely performed on pediatric patients. We show a pediatric patient who underwent SSpPD because of benign duodenal stenosis and Groove pancreatitis associated with duodenal ulcer. Case: A 14-year-old boy had been suffered from repeated abdominal pain of unknown cause for 5 years. Because of abdominal pain and vomiting, he was referred to our hospital, and diagnosed with duodenal stenosis and Groove pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated a biliary-duodenal fistula and the main pancreatic duct stenosis in the pancreas head. Although endoscopic pancreatic stenting was performed into the narrowed pancreatic duct, the replacement of stent became difficult due to the exacerbation of duodenal stenosis, and the patient was introduced to our department for surgery. Treatment course: SSpPD was performed. Operation time was 6 hours 49 minutes, and the amount of blood loss was 10 ml. He could take a solid diet postoperatively, and was discharged without any complication 18 days after the surgery. Discussion: There are several reports of pancreaticoduodenectomy in children for malignant tumors, but reports of benign diseases such as this case are extremely rare. Considering the requirement of long-term prognosis and quality of life, the operative indication of SSpPD for pediatric patient with benign diseases should be carefully decided.