title: Ductal branch-oriented pancreatic resection for an intraductal papillary mucinous neoplasm in the uncinate process that caused recurrent acute pancreatitis: a case report of successful treatment.
abstract: Acute pancreatitis reportedly occurs in about 15 % of cases of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs), with two-thirds of BD-IPMNs being located in the head or uncinate process of the pancreas. However, the surgical indications and optimal treatment methods for BD-IPMNs have not been established. A 59-year-old Japanese male with epigastralgia was admitted to our hospital. A multidetector row computed tomography (MDCT) scan disclosed grade I acute pancreatitis. Magnetic resonance cholangiopancreatography disclosed a 1.5-cm BD-IPMN in the uncinate process. Two months after discharge, the epigastralgia recurred, and MDCT again revealed grade I pancreatitis. Due to the repeated episodes of pancreatitis, we performed ductal branch-oriented pancreatic resection. To detect the inferior branch of the Wirsung duct and avoid the development of a pancreatic fistula, we injected indigo carmine into the tumor which confirmed ligation of the inferior branch. Histopathologically, the tumor proved to be an adenoma. The postoperative course was uneventful in both the short- and long-term follow-up and, to date, there has been no recurrence of pancreatitis, or diabetes mellitus during the 6 years since pancreatectomy. This procedure is one of the methods that can be used for the successful resection of a BD-IPMN in the uncinate process that caused recurrent acute pancreatitis.
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan. tnatsu22@yahoo.co.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Natsume
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Maruyama
authors.affiliation: Department of Internal Medicine, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Pathology, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuzaki
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Akinari
authors.initials: A
authors.lastname: Miyazaki
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Ohta
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Mizuho
authors.initials: M
authors.lastname: Aikawa
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Otsuka
authors.affiliation: Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan.
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Yanagihara
keywords: Acute pancreatitis; IPMN; Uncinate process