Department of Hepatopancreatobiliary Surgery, Foguang Hospital of Emei Mountain, Emei Mountain, Si Chuan, China.
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Si Chuan, PR China.
Medicine (Baltimore). 2023 May 26;102(21):e33840. doi: 10.1097/MD.0000000000033840.
Intraductal papillary mucinous neoplasms (IPMN) of the accessory pancreatic duct (APD) are very rare and their clinical significance is not known. Here, we describe a case of IPMN originating in a branch of the duct of APD within the uncinate process of the pancreas, which initially presented with acute pancreatitis.
A 70-year-old man visited our medical center presenting with acute pancreatitis around the head and uncinate process of the pancreas.
Computer tomography scans revealed the presence of a 35-mm cystic mass-like lesion within the pancreas uncinate process communicating with a branch of the APD. The patient was diagnosed with APD-IPMN in the pancreas uncinate process accompanied by acute pancreatitis.
Conservative management of the acute pancreatitis relieved his symptoms, while duodenum-preserving partial pancreatic head resection (DPPHR-P) was performed to treat the APD-IPMN. Intraoperative exploration showed the presence of severe adhesions within the uncinate process of the pancreas and that the tumor's "peduncle" - a branch of the duct of APD - was saddling just at the front of the main pancreatic ducts. Thus, surgical removal of the tumor required special handling of the region between the main duct (MD) and APD to protect the integrity of the main pancreatic ducts. Finally, a 353015 mm IPMN was successfully removed and the MD was preserved combined with ligation from the root of the APD of the pancreas. The drainage volume of the ventral tube increased by around 20-fold in 24 hours on the fourth day after surgery. The presence of high amylase levels in the drainage discharge (40713.5 U/L) led to the diagnosis of postoperative pancreatic fistula (POPF). The drainage volume remained high for 3 days.
The patient was discharged and POPF was successfully managed through endoscopic pancreatic duct stenting.
APD-IPMN in the pancreas uncinate process has its own characteristics of localized pancreatitis, and MD-preserving DPPHR-P not only protects the exocrine and endocrine functions of the pancreas, but it also protects the physiological and anatomical integrity. The appearance of POPF after DPPHR-P may be managed by endoscopic pancreatic duct stenting.
胰副导管（APD）内的管内乳头状黏液性肿瘤（IPMN）非常罕见，其临床意义尚不清楚。在此，我们描述了一例起源于胰腺钩突内 APD 分支的 IPMN 病例，该病例最初表现为急性胰腺炎。
一名 70 岁男性因急性胰腺炎就诊于我院，病变位于胰头和胰腺钩突周围。
计算机断层扫描显示胰腺钩突内存在一个 35mm 的囊性肿块样病变，与 APD 的分支相通。患者被诊断为胰腺钩突内 APD-IPMN 合并急性胰腺炎。
对急性胰腺炎进行保守治疗缓解了患者的症状，随后进行保留十二指肠的胰头部分切除术（DPPHR-P）治疗 APD-IPMN。术中探查发现胰腺钩突内存在严重粘连，肿瘤的“蒂”（APD 的分支）正好骑跨在主胰管前方。因此，切除肿瘤需要特别处理主胰管（MD）和 APD 之间的区域，以保护主胰管的完整性。最终，成功切除了一个 353015mm 的 IPMN，保留了 MD，并结扎了胰腺的 APD 根部。术后第 4 天，引流管的引流量增加了约 20 倍，达到 20ml/h。引流液中淀粉酶水平升高（40713.5U/L），诊断为术后胰瘘（POPF）。引流量持续升高 3 天。
患者出院，POPF 经内镜胰管支架置入成功治疗。
胰腺钩突内的 APD-IPMN 具有局部胰腺炎的特征，MD 保留的 DPPHR-P 不仅保护了胰腺的外分泌和内分泌功能，而且保护了胰腺的生理和解剖完整性。DPPHR-P 后发生 POPF 可能通过内镜胰管支架置入来治疗。
