Portal Annular Pancreas Research Articles

Portal annular pancreas: An unusual pancreatic anomaly

Portal annular pancreas: An unusual pancreatic anomaly

Congenital duodenal obstruction due to duodenal atresia with preduodenal portal vein, annular pancreas, and intestinal malrotation associated with situs inversus abdominis: A case report

Abstract The operations for congenital duodenal obstruction due to duodenal atresia with, annular pancreas still present a unique challenge. Of the operative techniques mentioned in the literature duodenoduodenostomy was the most frequently performed, however peculiar situations may arise that may warrant gastrojejunostomy. We report a case of duodenal obstruction due to duodenal atresia with preduodenal portal vein, and annular pancreas, co-existing with intestinal malrotation, a right sided stomach and spleen in which, the patient had gastrojejunostomy.

Portal Annular Pancreas With Retroportal Pancreatic Duct Diagnosed With Endoscopic Ultrasound

Portal Annular Pancreas With Retroportal Pancreatic Duct Diagnosed With Endoscopic Ultrasound

Operative management of portal annular pancreas during pancreaticoduodenectomy

Fig 1. Axial-cut pancreatic protocol CT image at the level of the pancreatic neck. The PD (arrowheads) is seen just to the left of the PV (open arrow) and as it courses posterior to the PV. Retroportal pancreatic tissue is shown by the closed arrow. AN 81-YEAR OLD WOMAN presented with melenic stool and anemia. Upper endoscopy and endoscopic ultrasound revealed a large, bleeding submucosal mass in the duodenum that invaded the pancreas. Biopsies were inconclusive. Computed tomography (CT) of the chest, abdomen, and pelvis were obtained without signs of metastasis. Clinically, she was diagnosed with a localized duodenal gastrointestinal stromal tumor, and a pancreaticoduodenectomy was recommended. Evaluation of the preoperative pancreatic protocol CT demonstrated pancreatic tissue encircling the portal vein (PV) and superior mesenteric vein (SMV) with the pancreatic duct (PD) branching to the left of the vessels in the body and rejoining to the right of the vessels in the head of the pancreas (Fig 1). During the operation, the aberrant anatomy was clearly demonstrated by intraoperative ultrasonography, which confirmed that the PD and parenchyma encircled the PV/SMV. After

門脈輪状膵を伴った膵頭部癌の1例

膵が門脈を輪状に巻き込んだ門脈輪状膵は非常に稀な膵形態異常である．通常は無症状であるが，膵頭部手術を行うに際して様々な問題に遭遇することがある．今回，門脈輪状膵を伴った膵頭部癌に対し，亜全胃温存膵頭十二指腸切除術を施行した症例を経験したので，若干の考察を加え報告する．症例は60歳の男性．閉塞性黄疸の診断にて当院紹介となった．膵頭部癌または下部胆管癌疑いで平成24年2月に手術を施行した．術中に門脈輪状膵が存在し，しかも主膵管が門脈背側を走行していることが明らかになった．再建は膵腸吻合を行ったが，膵切離断端が通常よりも広いため，吻合に工夫を要した．術後は膵瘻を合併したが保存的治療で改善した．膵頭十二指腸切除術においては，術前の画像にて十分な膵頭部領域の解剖を把握し手術を行うことが肝要と思われた．

門脈輪状膵にreplaced―右肝動脈を伴った十二指腸乳頭部癌の1例

門脈輪状膵は，膵実質が門脈周囲を完全に包み込むまれな形態異常であり，“portal annular pancreas”として報告されている．今回，われわれは門脈輪状膵に上腸間膜動脈からのreplaced－右肝動脈を合併した十二指腸乳頭部癌の手術症例を経験したので報告する．患者は62歳の女性で，十二指腸乳頭部癌と診断され，亜全胃温存膵頭十二指腸切除術を施行した．術前より上腸間膜動脈からの右肝動脈のreplacementを認めていた．術中に膵鉤部が門脈周囲を巻き込むように背側から左側に伸びて存在し，膵体部と癒合する形態異常を認め，さらに膵実質内を右肝動脈が走行していた．主膵管が門脈腹側にあることを確認し，膵体部は上腸間膜静脈左縁で切離し，輪状になった膵鉤部は可及的に膵体部近傍で切離後に縫合閉鎖した．術後，膵液漏を認めたが，保存的治療にて軽快した．

Portal annular pancreasの膵奇形を伴った膵管内乳頭粘液性腺癌に対しmiddle-preserving pancreatectomyを施行した1例

Portal annular pancreasの膵奇形を伴った膵管内乳頭粘液性腺癌に対しmiddle-preserving pancreatectomyを施行した1例

Portal Annular Pancreas – A Case Report

Portal annular pancreas is one of the rarest congenital anomaly of the pancreas. This variation was noted in a formalin fixed male cadaver aged about 60 yrs during the course of routine anatomy dissection in MVJ Medical college and research hospital. Here the pancreatic parenchyma not only enclosed the second part of duodenum but also had surrounded the portal vein (PV). Such a variation requires careful consideration by the surgeon and gastroenterologists while performing pancreatic resection and various other procedures pertaining to the pancreas and duodenum.

Pancreaticoduodenectomy in portal annular pancreas: report of a case

Portal annular pancreas (PAP) is a rare anatomical anomaly in which the pancreatic parenchyma surrounds the superior mesenteric vein and portal vein (PV) annularly. This anomaly requires careful consideration in pancreatic resection. A case is presented and the technical issues are discussed. A 61-year-old female was referred to the hospital for suspected papilla Vater adenocarcinoma. Preoperative computed tomography showed that the PV was annularly surrounded by pancreatic parenchyma. Surgery revealed the uncinate process extended extensively behind the PV and fused with the pancreatic body. The pancreas was first divided above the PV, and it was divided again in the body after liberating the PV from pancreatic annulation. The postoperative course was uneventful without pancreatic fistula. It is safer to divide the pancreatic body on the left of the fusion between the uncinate process and the pancreatic body to reduce the risk of pancreatic fistula in pancreaticoduodenectomy for PAP.

Two Cases of Portal Annular Pancreas

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.

An extremely rare portal annular pancreas for pancreaticoduodenectomy with a special note on the pancreatic duct management in the dorsal pancreas

Fig 1. Dynamic CT imaging showing pancreatic tissue completely encircling the superior mesenteric vein (SMV; arrow) and a dilated main pancreatic duct in the tissue behind the SMV (arrow head). A PREVIOUSLY HEALTHY 81-YEAR-OLD WOMAN with general fatigue was admitted to our hospital in June 2009. Her blood chemistry data were within normal limits except for slightly elevated liver function values. Serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen were both normal. Gastroduodenoscopy showed an erosive tumor in the ampulla of Vater. Dynamic computed tomography (CT) revealed bilateral intrahepatic biliary dilatation, and the superior mesenteric vein (SMV) circumferentially embedded in the body of the pancreas, as well as a slightly dilated main pancreatic duct (MPD) in the tissue behind the SMV (Fig 1). The MPD was found posteriorly to the SMV and the accessory pancreatic duct (APD) was seen anteriorly to the SMV. The 2 ducts joined in the body of the pancreas to the left side of the

Portal annular pancreas, a notable pancreatic malformation: Frequency, morphology, and implications for pancreatic surgery

Portal annular pancreas (PAP) is a pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein. To the best of our knowledge, there have only been 3 reports of PAP in the literature. 1 Sugiura Y. Shima S. Yonekawa H. Yoshizumi Y. Ohtsuka H. Ogata T. The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery. Japan J Surg. 1987; 17: 182-185 Crossref PubMed Scopus (28) Google Scholar , 2 Mizuma M. Suzuki M. Unno M. Katayose Y. Rikiyama T. Takeuti H. et al. A case of “portal annular pancreas” in that the ventral pancreas joins with the pancreatic body encircling the portal vein. Tan to sui. 2001; 22: 963-966 Google Scholar , 3 Savastano S. Alessi S. Fantozzi O. Corra S. Zonta L. MRI diagnosis of a periportal annular pancreas. Eur J Radiol Extra. 2004; 50: 93-95 Crossref Scopus (5) Google Scholar During pancreatic resection, the presence of a PAP significantly affects the procedure, including the pancreaticointestinal reconstruction. Thus, it is important to recognize a PAP preoperatively; however, the frequency and characteristics of the anomaly have yet to be precisely determined. Our experience of technical difficulty during a pancreaticoduodenectomy in a patient with a PAP and distal bile duct adenocarcinoma led us to determine the frequency of PAP and its morphologic features. To this end, we reviewed abdominal contrast-enhanced multidetector computed tomographies (MDCTs) to determine the incidence of PAP.