title: Heterotopic pancreas autotransplantation with spleen for uncontrollable hemorrhagic pseudocyst and disabling pain in chronic pancreatitis.
abstract: OBJECTIVE
  In this study, we report on a heterotopic segmental pancreatic autotransplantation (HPAT) with spleen for alcoholic chronic pancreatitis with uncontrollable hemorrhagic pseudocyst and complete portal venous obstruction. The patient was a 72-year-old man who had an alcoholic chronic pancreatitis with severe abdominal pain and hemorrhagic pseudocyst. The first bleeding from a pseudoaneurism of the gastro-duodenal artery (GDA) to the cyst of pancreas head was stopped by interventional radiology (IVR) at our hospital on May 2010. The second bleeding happened with severe abdominal pain on February 15th, 2011; he was admitted on February 17. The IVR was not successful.
  
  
  METHODS
  There were two problems for the operation. The first was the severe inflammation and the second was the control of hemorrhage from GDA. We were afraid of the postoperative hemorrhage due to the leakage of pancreatic juice in the pancreato-duodenectomy (PD). Therefore, we chose the HPAT as a solution for postoperative hemorrhage and severe abdominal pain. After complete duodeno-pancreatectomy with spleen, we performed HPAT with spleen on March 8, 2011. The pancreatic duct reconstruction was performed by Roux-en-Y anastomosis to the jejunum.
  
  
  RESULTS
  The postoperative course was uneventful. The abdominal pain had resolved completely and the patient remained normoglycemic after HPAT.
  
  
  CONCLUSIONS
  We conclude that HPAT is a useful option for hemorrhagic pseudocyst of the pancreas head with severe abdominal pain of chronic pancreatitis.
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Services, Niigata City, Niigata, Japan. kanishok@med.niigata-u.ac.jp
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Oya
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Hidenaka
authors.initials: H
authors.lastname: Kokai
authors.forename: Kohei
authors.initials: K
authors.lastname: Miura
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D003251:Constriction, Pathologic; D004185:Disability Evaluation; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D010147:Pain Measurement; D016035:Pancreas Transplantation / Q000379:methods*; D010183:Pancreatic Ducts / Q000601:surgery; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D019512:Pancreatitis, Alcoholic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011169:Portal Vein / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures; D013154:Spleen / Q000637:transplantation*; D013156:Splenectomy; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome