Intraductal tubular carcinoma in an adenoma of the main pancreatic duct of the pancreas head

A 59-year-old woman was referred for investigation of a pancreatic cystic lesion. Computed tomography revealed a well-demarcated, multilocular cyst, approximately 4 cm in size, at the pancreas head. Endoscopic ultrasonography demonstrated honeycomb-like components at the cyst margin. The cyst was associated with a widely-dilated upstream main pancreatic duct (MPD). Endoscopic retrograde pancreatography demonstrated a communication between the stenotic Santorini‘s duct and the cyst. Aspiration cytology from the cyst demonstrated clusters of mucinous epithelial neoplasm cells. Branch-type intraductal papillary mucinous neoplasm, possibly invading to the MPD, was suspected and pancreatoduodenectomy was performed. Surprisingly, pathology of the resected pancreas showed mixed-type serous cystadenoma. Abbreviations: CA19-9: cancer antigen 19-9; CEA: carcinoembryonic antigen; ERC: endoscopic retrograde cholangiography; ENPD: endoscopic naso-pancreatic drainage ; ERP: endoscopic retrograde pancreatography; EUS: endoscopic ultrasonography; NET: neuroendocrine tumor; FNA: fine needle aspiration; IPMN: intraductal papillary mucinous neoplasm; MRCP: magnetic resonance cholangiopancreatography; MPD: main pancreatic duct; SCA: serous cystic neoplasms.

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Pancreas-preserving double pancreaticogastrostomy after traumatic injury to the head of the pancreas: a case report

Journal of International Medical Research ◽

10.1177/0300060520962967 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096296

Author(s):

Yuichi Aoki ◽

Hideki Sasanuma ◽

Yuki Kimura ◽

Akira Saito ◽

Kazue Morishima ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Traumatic Injury ◽

Pancreatic Head ◽

Pancreatic Injury ◽

Roux Limb ◽

Pancreas Head ◽

Pancreatic Fluid ◽

Head Of The Pancreas

Traumatic injury to the main pancreatic duct requires surgical treatment, but optimal management strategies have not been established. In patients with isolated pancreatic injury, the pancreatic parenchyma must be preserved to maintain long-term quality of life. We herein report a case of traumatic pancreatic injury with main pancreatic duct injury in the head of the pancreas. Two years later, the patient underwent a side-to-side anastomosis between the distal pancreatic duct and the jejunum. Eleven years later, he presented with abdominal pain and severe gastrointestinal bleeding from the Roux limb. Emergency surgery was performed with resection of the Roux limb along with central pancreatectomy. We attempted to preserve both portions of the remaining pancreas, including the injured pancreas head. We considered the pancreatic fluid outflow tract from the distal pancreatic head and performed primary reconstruction with a double pancreaticogastrostomy to avoid recurrent gastrointestinal bleeding. The double pancreaticogastrostomy allowed preservation of the injured pancreatic head considering the distal pancreatic fluid outflow from the pancreatic head and required no anastomoses to the small intestine.

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