From the Department of Surgery, Sapporo Kosei General Hospital, Sapporo, Japan.
Pancreas. 2021 Apr 1;50(4):639-644. doi: 10.1097/MPA.0000000000001766.
Portal annular pancreas (PAP) is a rare congenital pancreatic anomaly, in which the uncinate process of the pancreas fuses to the body of pancreas behind the portal vein. Here, we report a case of PAP with common hepatic arterial anomaly, which was identified during surgery. A 57-year-old man who had branch type intraductal papillary mucinous neoplasm in the head of the pancreas developed a nodule in the cystic lesion. We planned pylorus preserving pancreaticoduodenectomy. The common hepatic artery from the celiac artery passing behind the portal vein was revealed in preoperative examinations. During surgery, we discovered that the uncinate process of the pancreas was fused with the body of the pancreas behind the portal vein. We divided the pancreas at the anterior and posterior of the portal vein. The main pancreatic duct was present in the anterior pancreatic stump. We performed pancreaticojejunostomy in the anterior stump and closed the posterior stump by interrupted suture. Forty-four surgical cases of PAP have been reported in the English medical literature. There are few previous reports of PAP which involved an arterial anomaly. Clinicians should consider PAP preoperatively to ensure that the surgeon can appropriately plan pancreatic resection to avoid postoperative complications.
门静脉环胰腺（PAP）是一种罕见的先天性胰腺异常，其中胰腺的钩突与门静脉后方的胰腺体融合。在此，我们报告一例伴有肝总动脉异常的 PAP 病例，该病例是在手术中发现的。一名 57 岁男性患有胰头分支型胰管内乳头状黏液性肿瘤，在囊性病变中发现一个结节。我们计划行保留幽门的胰十二指肠切除术。术前检查显示，来自腹腔动脉的肝总动脉穿过门静脉后方。在手术过程中，我们发现胰腺的钩突与门静脉后方的胰腺体融合。我们在门静脉前后部分离胰腺。主胰管位于前胰腺残端。我们在前残端行胰肠吻合术，并间断缝合关闭后残端。英文医学文献中已有 44 例 PAP 的手术病例报告。此前很少有 PAP 合并动脉异常的报道。临床医生应在术前考虑 PAP，以确保外科医生能够适当规划胰腺切除术，避免术后并发症。
