Portal annular pancreas (PAP) is an asymptomatic congenital pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein and or the superior mesenteric vein. During pancreaticoduonectomy (PD), the presence of PAP significantly increased risk for postoperative pancreatic fistula (POPF) because specific management of 2 pancreatic resection planes with 1 or 2 pancreatic ducts is required for pancreatico-intestinal reconstruction. To reduce the risk of POPF, a shift of the resection plain to the left for 1 anastomosis is recommended. We report a case of PAP that was successfully performed PD with pancreaticogastrostomy (PG). PG was conducted with invagination of the 2 resected pancreatic planes together into the stomach to minimize resected volume of the pancreas. A 78-year-old male patient with PAP underwent PD due to a duodenal adenocarcinoma. Intraoperatively, the uncinate process extended extensively behind the portal vein and fused with the dorsal surface of the pancreatic body above the splenic vein. For pancreatico-intestinal reconstruction, PG was performed with invagination of the 2 resected pancreatic planes together into the stomach. The postoperative course was uneventful, and he was discharged on postoperative day 12. Endocrine and exocrine function of the pancreas were maintained well at 10 months after surgery. PG is one of the useful choices for patients with PAP to prevent POPF while maintaining the pancreatic endocrine and exocrine function after PD.
Surgical management of intraoperatively diagnosed portal annular pancreas
