title: Pancreaticoduodenectomy in portal annular pancreas: report of a case.
abstract: 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.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 18-22 Honkomagome 3-chome, Bunkyo-ku, Tokyo, Japan. koba-shindig@cick.jp
authors.forename: Shin
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Goro
authors.initials: G
authors.lastname: Honda
authors.forename: Masanao
authors.initials: M
authors.lastname: Kurata
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Okuda
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuruta
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008642:Mesenteric Veins / Q000002:abnormalities; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities* / Q000098:blood supply* / Q000601:surgery; D010185:Pancreatic Fistula / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011169:Portal Vein / Q000002:abnormalities / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D016896:Treatment Outcome