Ohta Mineto, Fukushima Keisuke, Nishimaki Hiroyasu, Morita Takayuki, Ito Yuta, Namiki Kenji
Department of Surgery, Osaki Citizen Hospital, Osaki, Japan.
Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Case Rep Gastroenterol. 2024 Apr 16;18(1):214-220. doi: 10.1159/000538370. eCollection 2024 Jan-Dec.
Portal annular pancreas (PAP) is a congenital anomaly resulting from aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein (PV). PAP was classified into three types by Joseph et al., based on the location of the main pancreatic duct around the PV. The presence of PAP is important for the surgical procedure because it is associated with the postoperative pancreatic fistula. There are no standardized surgical procedures of resection and reconstruction for PAP.
We report 2 cases of subtotal stomach-preserving pancreatoduodenectomy in patients with PAP. One case of PAP was discovered coincidentally intraoperatively, and the other case was diagnosed before surgery. The first case was an 84-year-old male patient who underwent surgery for distal bile duct cancer. PAP was noticed intraoperatively when the uncinate process of the pancreas was detached from behind the PV. The second case was an 84-year-old female patient who also underwent surgery for distal bile duct cancer. We recognized PAP from preoperative computed tomography images. In both cases, the ductal anatomy was consistent with type IIIA PAP, and the dorsal pancreas was resected using a stapling device. During the postoperative period, there was no clinically relevant postoperative pancreatic fistula.
PAP is rarely encountered intraoperatively; however, it is important to recognize it before surgery and take it into consideration when deciding upon the procedures for resection and reconstruction.
门静脉环周胰腺（PAP）是一种先天性异常，由围绕门静脉（PV）的腹侧和背侧胰芽异常融合所致。根据主胰管在PV周围的位置，Joseph等人将PAP分为三种类型。PAP的存在对手术操作很重要，因为它与术后胰瘘有关。目前尚无针对PAP的标准化切除和重建手术方法。
我们报告2例PAP患者行保留胃的胰十二指肠次全切除术。1例PAP在术中偶然发现，另1例在术前确诊。第1例为84岁男性患者，因远端胆管癌接受手术。术中当胰腺钩突从PV后方分离时发现PAP。第2例为84岁女性患者，同样因远端胆管癌接受手术。我们从术前计算机断层扫描图像中识别出PAP。两例患者的导管解剖结构均符合IIIA型PAP，使用吻合器切除背侧胰腺。术后期间，未出现具有临床意义的术后胰瘘。
术中很少遇到PAP；然而，术前识别并在决定切除和重建手术时予以考虑很重要。
