A Case of Bile Duct Carcinoma with a Portal Annular Pancreas

There has been little report on the presence of a hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein , and has been described as a portal annular pancreas or circumportal pancreas. We recently experienced a case of a patient in whom the pancreatic uncinate process su...

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Published inThe Japanese Journal of Gastroenterological Surgery Vol. 45; no. 2; pp. 191 - 196
Main Authors Kato, Hiroyuki, Kitashiro, Shuji, Okushiba, Shunnichi, Miyasaka, Daisuke, Ebihara, Yuma, Watanabe, Yusuke, Kawarada, Yo, Saikawa, Daisuke, Sasaki, Takeshi
Format Journal Article
LanguageJapanese
Published The Japanese Society of Gastroenterological Surgery 2012
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ISSN0386-9768
1348-9372
DOI10.5833/jjgs.45.191

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Abstract There has been little report on the presence of a hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein , and has been described as a portal annular pancreas or circumportal pancreas. We recently experienced a case of a patient in whom the pancreatic uncinate process surrounded the superior mesenteric vein. An 84-year-old woman with jaundice was given a diagnosis of lower bile duct cancer, and underwent surgery. During pancreatoduodectomy, we found an anomaly of the pancreas encasing the superior mesenteric vein. A computed tomography (CT) scan confirmed that the main pancreatic duct was passing through the anterior portion of the superior mesenteric vein, and we performed standard dissection of the pancreatic parenchyma antecedent to the superior mesenteric vein. After exposing the main pancreatic duct, we dissected the retroportal region, and the anomalous pancreatic parenchyma with autosutures on the left border of the superior mesenteric vein. Postoperatively, a pancreatic fistula, classified as Group A according to the International Study Group on Pancreatic Fistulas Classification, developed but improved with conservative management.
AbstractList There has been little report on the presence of a hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein , and has been described as a portal annular pancreas or circumportal pancreas. We recently experienced a case of a patient in whom the pancreatic uncinate process surrounded the superior mesenteric vein. An 84-year-old woman with jaundice was given a diagnosis of lower bile duct cancer, and underwent surgery. During pancreatoduodectomy, we found an anomaly of the pancreas encasing the superior mesenteric vein. A computed tomography (CT) scan confirmed that the main pancreatic duct was passing through the anterior portion of the superior mesenteric vein, and we performed standard dissection of the pancreatic parenchyma antecedent to the superior mesenteric vein. After exposing the main pancreatic duct, we dissected the retroportal region, and the anomalous pancreatic parenchyma with autosutures on the left border of the superior mesenteric vein. Postoperatively, a pancreatic fistula, classified as Group A according to the International Study Group on Pancreatic Fistulas Classification, developed but improved with conservative management.
Author Ebihara, Yuma
Kawarada, Yo
Okushiba, Shunnichi
Sasaki, Takeshi
Kitashiro, Shuji
Miyasaka, Daisuke
Kato, Hiroyuki
Saikawa, Daisuke
Watanabe, Yusuke
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  organization: Department of Surgery, Tonan Hospital
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  fullname: Okushiba, Shunnichi
  organization: Department of Surgery, Tonan Hospital
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  fullname: Miyasaka, Daisuke
  organization: Department of Surgery, Tonan Hospital
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  fullname: Ebihara, Yuma
  organization: Department of Surgery, Tonan Hospital
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  fullname: Watanabe, Yusuke
  organization: Department of Surgery, Tonan Hospital
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  fullname: Kawarada, Yo
  organization: Department of Surgery, Tonan Hospital
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  fullname: Saikawa, Daisuke
  organization: Department of Surgery, Tonan Hospital
– sequence: 1
  fullname: Sasaki, Takeshi
  organization: Department of Surgery, Tonan Hospital
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References 10) Marjanovic G, Obermaier R, Benz S, Bley T, Juettner E, Hopt UT, et al. Complete pancreatic encasement of the portal vein: surgical implications of an extremely rare anomaly. Langenbecks Arch Surg. 2007;392:489-91.
3) Sugiura Y, Shima S, Yonekawa H, Yoshizumi Y, Ohtsuka H, Ogata T. The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery. Jpn J Surg. 1987;17:182-5.
6) Leyendecker JR, Baginski SG. Complete pancreatic encasement of the portal vein (circumportal pancreas): imaging findings and implications of a rare pancreatic anomaly. J Comput Assist Tomogr. 2008;32:61-4.
7) Hashimoto Y, Ross AS, Traverso LW. Circumportal pancreas with retroportal main pancreatic duct. Pancreas. 2009;38:713-5.
5) Karasaki H, Mizukami Y, Ishizaki A, Goto J, Yoshikawa D, Kino S, et al. Portal annular pancreas, a notable pancreatic malformation: Frequency, morphology, and implications for pancreatic surgery. Surgery. 2009;146:515-8.
1) 高田忠敬.膵の区域—概念と臨床—応用.Frontier in Gastroenterology.1998;3:33-43.
8) Joseph P, Raju RS, Vyas FL, Eapen A, Sitaram V. Portal Annular Pancreas. A Rare Variant and a New Classification. JOP. 2010 Sep 6;11(5):453-5.
4) 水間正道,鈴木正徳,海野倫明,片寄 友,力山敏樹,竹内丙午,ほか.腹側膵が門脈を輪状に巻き込み膵体部と癒合したいわゆる "portal annular pancreas" の1例.胆と膵.2001;22(11):963-6.
2) 日本膵臓学会編.膵臓癌取扱い規約.第6版.金原出版
9) Hamanaka Y, Evans J, Sagar G, Neoptolemos JP. Complete pancreatic encasement of the proximal hepatic portal vein: a previously undescribed congenital anomaly. Br J Surg. 1997;84:785.
References_xml – reference: 1) 高田忠敬.膵の区域—概念と臨床—応用.Frontier in Gastroenterology.1998;3:33-43.
– reference: 4) 水間正道,鈴木正徳,海野倫明,片寄 友,力山敏樹,竹内丙午,ほか.腹側膵が門脈を輪状に巻き込み膵体部と癒合したいわゆる "portal annular pancreas" の1例.胆と膵.2001;22(11):963-6.
– reference: 9) Hamanaka Y, Evans J, Sagar G, Neoptolemos JP. Complete pancreatic encasement of the proximal hepatic portal vein: a previously undescribed congenital anomaly. Br J Surg. 1997;84:785.
– reference: 5) Karasaki H, Mizukami Y, Ishizaki A, Goto J, Yoshikawa D, Kino S, et al. Portal annular pancreas, a notable pancreatic malformation: Frequency, morphology, and implications for pancreatic surgery. Surgery. 2009;146:515-8.
– reference: 10) Marjanovic G, Obermaier R, Benz S, Bley T, Juettner E, Hopt UT, et al. Complete pancreatic encasement of the portal vein: surgical implications of an extremely rare anomaly. Langenbecks Arch Surg. 2007;392:489-91.
– reference: 7) Hashimoto Y, Ross AS, Traverso LW. Circumportal pancreas with retroportal main pancreatic duct. Pancreas. 2009;38:713-5.
– reference: 8) Joseph P, Raju RS, Vyas FL, Eapen A, Sitaram V. Portal Annular Pancreas. A Rare Variant and a New Classification. JOP. 2010 Sep 6;11(5):453-5.
– reference: 3) Sugiura Y, Shima S, Yonekawa H, Yoshizumi Y, Ohtsuka H, Ogata T. The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery. Jpn J Surg. 1987;17:182-5.
– reference: 6) Leyendecker JR, Baginski SG. Complete pancreatic encasement of the portal vein (circumportal pancreas): imaging findings and implications of a rare pancreatic anomaly. J Comput Assist Tomogr. 2008;32:61-4.
– reference: 2) 日本膵臓学会編.膵臓癌取扱い規約.第6版.金原出版.
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Snippet There has been little report on the presence of a hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein , and has been described...
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SubjectTerms aberrant pancreas
pancreatoduodenectomy
Title A Case of Bile Duct Carcinoma with a Portal Annular Pancreas
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