Circumportal Pancreas-a Must Know Pancreatic Anomaly for the Pancreatic Surgeon.
Circumportal pancreas is a rare congenital pancreatic anomaly with encasement of the portal vein and/or the superior mesenteric vein by pancreatic tissue. It is often overlooked on cross-sectional imaging studies and can be encountered during pancreatic surgery. Pancreatic head resection with circumportal pancreas is technically difficult and bears an increased risk of postoperative pancreatic fistula.



A retrospective chart review of our data base for all patients who had undergone pancreatic head resection between 2004 and 2015 was performed.



We identified six patients out of 1102 patients who had undergone pancreatic head surgery in the study period. CT-scan and MRI were never able to identify circumportal pancreas prior to surgery. The right hepatic an artery derived from the superior mesenteric artery in four cases (67%). Additional resection of the pancreatic body was always performed. Postoperative course was uneventful in all cases without occurrence of pancreatic fistula.



Circumportal pancreas is a rare entity every pancreatic surgeon should be aware of. It is difficult to identify on cross-sectional imaging studies. A right hepatic artery arising from the superior mesenteric artery should raise suspicion of circumportal pancreas. Additional pancreatic tissue resection should be performed during pancreatic head resections to avoid pancreatic fistula.
Katholisches Klinikum Bochum - St. Josef Hospital, Klinik für Allgemein-und Viszeralchirurgie, Gudrunstrasse 56, 44791, Bochum, Germany. a.luu@klinikum-bochum.de.
Andreas Minh
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Luu
Katholisches Klinikum Bochum - St. Josef Hospital, Klinik für Allgemein-und Viszeralchirurgie, Gudrunstrasse 56, 44791, Bochum, Germany.
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Braumann
Katholisches Klinikum Bochum - St. Josef Hospital, Klinik für Allgemein-und Viszeralchirurgie, Gudrunstrasse 56, 44791, Bochum, Germany.
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Herzog
Katholisches Klinikum Bochum - St. Josef Hospital, Klinik für Allgemein-und Viszeralchirurgie, Gudrunstrasse 56, 44791, Bochum, Germany.
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Janot
Katholisches Klinikum Bochum - St. Josef Hospital, Klinik für Allgemein-und Viszeralchirurgie, Gudrunstrasse 56, 44791, Bochum, Germany.
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Uhl
Asklepios Klinikum Harburg, Allgemein- und Viszeralchirurgie, Eissendorfer Pferdeweg 52, 21075, Hamburg, Germany.
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Chromik
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior; D008642:Mesenteric Veins; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities* / Q000098:blood supply* / Q000601:surgery; D010180:Pancreatectomy; D011169:Portal Vein; D012189:Retrospective Studies
Complete pancreatic encasement of the portal vein; Pancreatic embryology; Pancreatic resection; Portal annular pancreas; Retroportal pancreas