title: Pancreatic cyst associated with pancreas divisum treated by laparoscopy-assisted cystgastrostomy in the intragastric approach: a case report and a review of the literature.
abstract: A 39-year-old Japanese man was admitted to our hospital after experiencing recurrent episodes of pancreatitis over the previous 2 years. On the first episode, he had been admitted to our hospital with elevated serum amylase levels and epigastralgia. Abdominal computed tomography (CT) revealed a diffuse, uncircumscribed area with heterogeneous density in the pancreas. No previous history of pancreatitis, gallstones, drinking, or abdominal injury was elicited. Magnetic resonance cholangiopancreatography (MRCP) demonstrated that the Wirsung duct was unconnected to the Santorini's duct. Endoscopic retrograde cholangiopancreatography through the papilla of Vater and accessory papilla revealed an enlarged ventral pancreatic duct, pancreas divisum, and a cystic lesion in the pancreatic body. On the second and third episodes, endoscopic drainage of the pancreatic pseudocysts through the accessory papilla and ultrasonography-guided transmural drainage were unsuccessful. A follow-up CT and MRCP demonstrated that the pancreatic cyst had enlarged to 9 x 8 cm in diameter. A laparoscopy-assisted cystgastrostomy was performed with an intragastric approach. An anastomosis was performed using an endoscopic linear stapler through the small cystotomy and gastrotomy openings on the posterior wall of the stomach. The postoperative clinical course was uneventful. Over 6 months later, the patient remains well and with a good quality of life. A laparoscopy-assisted cystgastrostomy, using an intragastric surgical technique, offers a safe, less-invasive procedure for cyst drainage by the pancreas divisum.
authors.affiliation: Department of Surgery, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan. matsutani@nms.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsutani
authors.forename: Koji
authors.initials: K
authors.lastname: Sasajima
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyamoto
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Makoto
authors.initials: M
authors.lastname: Hiroi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Seiji
authors.initials: S
authors.lastname: Suzuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010181:Pancreatic Cyst / Q000150:complications* / Q000601:surgery; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000601:surgery; D011860:Radiography, Abdominal; D012008:Recurrence; D017792:Surgical Stapling; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional