Search

Aim. Study of anatomical variations of the pancreatic neck blood supply, which may affect the results of pancreaticoduodenectomy.Material and methods. Anatomic characteristics of arterial blood supply of pancreas were studied in 42 autopsied cases, who died from diseases not associated with abdominal organs failure. Clinical part of our study included 62 patients. Arterial anatomy was examined during early arterial phase of computer tomography. Options of the origin of the dorsa pancreatic artery were noted. All patients had “soft” pancreas confirmed by morphological examination and computer tomography. Main group included 20 patients. Dissection of the pancreas during pancreatoduodenectomy in this group were performed 10–15 mm left of portal vein confluence. Control (retrospective) group included 42 patients performed standard procedure, when pancreas was dissected above the portal vein confluence.Results. It was found that the neck of pancreas was supplied from dorsal pancreatic artery, found in all specimens. In 76% of cases it was a branch of splenic artery, in other cases – a branch of superior mesenteric artery. CT scan revealed the dorsal pancreatic artery in 54 (87.1%) people, in 8 patients the artery could not be identified. The dorsal pancreatic artery was a branch of the splenic artery in 64.8% of cases. In other cases it was a branch of the superior mesenteric artery, common hepatic artery, gastroduodenal artery and middle colon artery. If the dorsal pancreatic artery was a branch of the superior mesenteric, common hepatic, gastroduodenal artery, it was transected during lymphadenectomy. This led to higher frequency of postoperative pancreatic fistula.Conclusion. Localization of dorsal pancreatic artery must be taken into account during the pancreatoduodenectomy. That allows to decrease probability of postoperative pancreatic fistula.

Inflammatory myofibroblastic tumor (IMT) is a rare disease of unknown etiology. It usually occurs in abdominal soft tissues and lung, and is extremely rare in the pancreas. IMT can occur in any part of a person at any age, however, it mostly affects children and young people. Its clinical manifestations are atypical, imaging examinations are not specific, and the differential diagnosis of pancreatic malignancies is difficult, making it easily misdiagnosed. Surgical resection is the preferred method of treatment for IMT. In this case report, we report a rare case of IMT in the neck of the pancreas and reviewed the relevant literature. In our case, the patient was a 57-year-old woman with an IMT in the neck of the pancreas. Abdominal pain was the only clinical symptom, and imaging features were not specific. She underwent surgery to remove the pancreatic mass, and the final diagnosis of IMT was based on histopathology and immunohistochemistry. After 6 months of regular follow-up, the patient had no complications or further incidents. The purpose is to emphasize the difficulty of the preoperative diagnosis of pancreatic IMT and the difficulty of distinguishing it from pancreatic malignancies. It is hoped that clinicians can gain a deeper understanding of pancreatic IMT through this case report.

Background: Portal vein drains blood from the abdominal part of alimentary tract, spleen, pancreas and gall bladder to the liver. It is normally formed by the union of superior mesenteric and splenic veins behind the neck of pancreas. Knowledge of variations regarding the formation of portal vein is very useful for surgeons to perform pancreas and duodenum and liver surgeries and for the interventional radiologist for catheter-based interventions. The objectives of this study are to disclose the variations in formation of hepatic portal vein and to measure the length of portal vein in cadavers. Methods: A descriptive cross sectional study was carried out on 40 embalmed cadavers in the Department of Human Anatomy, KIST Medical College, Lalitpur Nepal after taking ethical approval. The pattern of portal vein formation and its tributaries were identified and photographs were taken. The pattern of portal vein formation was classified as: Type I: Portal vein formed by the confluence of superior mesenteric and splenic vein ; Type II: portal vein formed by the confluence of superior mesenteric, splenic and inferior mesenteric vein . Data was analyzed by using SPSS version 20.Results: Type I pattern of portal vein formation was observed in 31 cadavers (82.5%) while Type II pattern was observed in 5 cadavers (12.5%). Average length of portal vein was 50.58mm. Conclusions: Portal vein shows variations in the pattern of formation which should be taken into consideration during pancreatico-duodenal surgeries and in the interpretation of abdominal angiographs.Keywords: Length; portal vein; variations.

Background Skip lymphatic metastasis (SK) is an exceptional and characteristic pattern of lymph node metastasis in gastric cancer (GC) with infrequent incidence. This is an extremely rare report of occult gastric cancer with solitary skip lymphatic metastasis as the initial and primary observation. Case presentation A 61-year-old woman, who complained of epigastric discomfort for several years, presented a solitary nodule upon pancreas neck examination by CT without performance on the primary lesion, even gastroscopy. During the preoperative 4-month follow-up, the nodule stayed stable without any therapy. The postoperative pathological examination confirmed the consistent diagnosis of gastric adenocarcinoma between the nodule and the stomach lesion, which was found by preoperative random biopsy of the mucosa. Conclusions This case highlights the concentration on vigilance to the SK of GC and a closer observation for intra-abdominal nodules, even radiological suspicion of a benign lesion.

A 62‑year‑old female presented with abdominal pain and was diagnosed as acute on chronic pancreatitis based on elevated serum amylase and imaging findings. The pancreatic duct was dilated with abrupt cutoff at neck of pancreas, but no mass was visualized. Positron emission tomography‑computed tomography (PET‑CT) revealed a fluorodeoxyglucose (FDG) avid lesion in the neck of the pancreas but ultrasound (USG)‑guided fine‑needle aspiration (FNA) from the lesion revealed only inflammatory cells. Endoscopic ultrasound, done 2 days after USG‑guided FNA, revealed pseudoaneurysm (PA) in the neck of pancreas that was confirmed on CT angiography. The PA was occluded by USG‑guided percutaneous cyanoacrylate injection. As pain persisted, repeat PET CT was done which revealed FDG avidity around the cyanoacrylate cast as well in multiple small hypodense lesions in the right lobe of the liver. USG‑guided FNA from both the liver lesion as well as the periphery of the glue cast revealed features of adenocarcinoma. We herein report a case of pancreatic adenocarcinoma that presented as acute pancreatitis and got masked because of formation of PA consequent to USG‑guided FNA.

Introducción: el tronco venoso gastrocólico, según lo descrito por Henle en 1868 se forma de la confluencia de las venas gastroepiploica derecha, cólica derecha y pancreático duodenal anteroinferior. Su localización y conocimiento anatómico es de importancia quirúrgica en la movilización duodeno pancreática y colo-epiploica. Material y métodos: se utilizaron 13 cadáveres formolados, adultos, de ambos sexos. Se registró: formación del tronco venoso gastrocólico, calibre de los afluentes y del tronco, distancias entre: cuello del páncreas y borde superior del duodeno III, vena mesentérica superior a duodeno II. Se topografió el tronco venoso en relación a las estructuras mencionadas. Se registró largo del tronco, distancia al borde superior del duodeno III y al borde inferior del cuello de Páncreas. Resultados: la conformación más frecuente fue por confluencia de las venas cólica derecha, gastroepiploica derecha y pancreático duodenal anteroinferior. El calibre medio del tronco venoso fue 5,65mm (3,3mm-10mm). La distancia media entre duodeno III y cuello de páncreas fue de 31,34mm (13,2mm-51mm). La distancia media entre vena mesentérica superior y duodeno II fue de 34,23mm (23,8mm-45,7mm). El largo medio del tronco venoso fue 9,43mm (3,2mm-16,3mm). Conclusión: se constató, en la mayoría de los casos, que la confluencia de formación del tronco venoso se daba según lo descrito clásicamente. Este se situó más frecuentemente de disposición oblicua hacia abajo y adentro, y en el cuadrante ínfero-interno respecto al cuadrilátero dado por una línea vertical desde cuello del páncreas a duodeno III y una horizontal desde duodeno II hasta la vena mesentérica superior.

Despite the major advances in the field of trauma management. High grade Blunt pancreatic injury remains a disease with both high mortality and morbidity specially in cases of delayed diagnosis. Herein we will present a case report of 31 years old Saudi male who was involved in motor vehicle accident with a delayed diagnosis of pancreatic injury associated with other multiple injuries. He was diagnosed late on 12th day of admission during laparotomy where a missed high-grade pancreatic fracture at the neck of pancreas, massive pancreatic ascites and extensive pancreatic necrosis was found. Open abdominal closure technique with mesh mediated fascial closure and Vacuum assisted closure was used to improve both respiratory function and abdominal disease through repeated debridement with peritoneal lavage and sequential approximation of fascia. He responded well gradually and offered definitive closure of fascia and feeding jejunostomy. Unfortunately, he had a sudden stroke followed by rapid deterioration then expired 48 hours later.

Portal vein provides about three-fourths of liver's blood supply. Portal vein is formed behind the neck of pancreas, at the level of the second lumbar vertebra and formed from the convergence of superior mesenteric and splenic veins. The purpose of this study is to review the normal distribution and variation, morphometry of portal vein and its branches for their implication in liver surgery and preoperative portal vein embolization. It is also helpful for radiologists while performing radiological procedures. A total of fresh 40 livers with intact splenic and superior mesenteric vein were collected from the mortuary of Forensic Department, JSS Medical College and Mysuru Medical College. The silicone gel was injected into the portal vein and different segments were identified and portal vein variants were noted. The morphometry of portal vein was measured by using digital sliding calipers. The different types of portal vein segmental variants were observed. The present study showed predominant type I in 90% cases, type II 7.5% cases, and type III 2.5% cases. Mean and standard deviation (SD) of length of right portal vein among males and females were 2.096±0.602 cm and 1.706±0.297 cm, respectively. Mean and SD of length of left portal vein among males and females were 3.450±0.661 cm and 3.075±0.632 cm, respectively. The difference in the Mean among the males and females with respect to length of right portal vein and left portal vein was found to be statistically significant (P=0.010). Prior knowledge of variations regarding the formation, termination and tributaries of portal vein are very helpful and important for surgeons to perform liver surgeries like liver transplantation, segmentectomy and for Interventional Radiologists.

Pseudopapillary cystic neoplasm of the pancreas (Frantz tumor) is rare slow growing tumor with low malignant potential usually affecting young women. PCN have good prognosis in case of radical removal. Tumor was described for the first time by Frantz in 1959. A retrospective clinical analyses was made of two patients with PCN admitted in our hospital in the last 10 years. A 16 year old girl admitted in our hospital with intermittent abdominal pain lasting for 3 years. Abdominal ultrasound and CT-scan showed the presence of the tumor in a head of pancreas. Excision was performed. A 13 year boy came to routine US because frequent urological infection. Abdominal US and after CT are showed the presence of the tumor in a neck of pancreas. Excision was performed. In both of patients metastases were not noticed. The follow up period was 9 years in female patient and 2 years in male patient, Surgical resection of PCN affords an excellent prognosis without other ways of treatments.

Objective: To investigate the clinical application of binding pancreaticogastrostomy (BPG) anastomosis in medial pancreatectomy(MP). Methods: The clinical data of 62 patients with benign and low-grade malignant lesions in neck and body of pancreas who received medial pancreatectomy combined with binding pancreaticogastrostomy anastomosis from January 2010 to October 2014 were retrospectively analyzed. MP: Several surgical approaches were combined used to finish the pass-through of the neck of pancreas as the common hepatic artery, portal vein, superior mesenteric vein and splenic vein for the anatomic axis. The pancreas was transected apart from the tumor 1 cm. The proximal stump was closed by interrupted sutures after the main pancreatic duct was ligated. Dissecting the tumor-burdened pancreas and ligating the branch vessels between the splenic vessels and pancreas exactly. After identification of the distal main pancreatic duct, a stent was implanted and fixed. BPG: The reconstruction began with a mobilization of distal pancreatic stump for 3-4cm. After evaluating the size and position of pancreatic stump, a purse-string suture was preset around the sero-muscular layer of the posterior gastric wall. A small gastrostomy was performed in this area with a size equivalent to accommodate the pancreatic stump. An incision was made at the anterior gastric wall. The pancreas remnant was pulled into the gastric cavity. The purse-string, as the outer binding, was tied just enough for anastomosis and the endogastric mucosa and pancreatic capsule were interrupted sutured. The incision on the anterior gastric wall was closed with a closure device. Results: Operation was successfully performed on all patients. The mean operation time was 155 min, the mean blood loss was 300 ml and the mean postoperative length of hospital stay was 10.5 days. 6 patients had postoperative pancreatic fistula (2 were Grade B and 4 were Grade A). The follow-up range time was 3 ~ 36 months. None of the 62 patients were found to have pancreatic endocrine or exocrine insufficiency or formation of pseudo pancreatic cyst. Conclusion: Medial pancreatectomy showed trauma little, quick recovery and maximum protection the pancreatic exocrine and endocrine function which should be realized as a preferred treatment for pancreas injury and the benign or low-grade malignant tumor in neck and body of pancreas. Binding pancreaticogastrostomy anastomosis could effectively reduce the incidence of pancreatic fistula which should be a ideal reconstruction mode in medial pancreatectomy.

Objective: To investigate the clinical application of binding pancreaticogastrostomy (BPG) anastomosis in medial pancreatectomy(MP). Methods: The clinical data of 62 patients with benign and low-grade malignant lesions in neck and body of pancreas who received medial pancreatectomy combined with binding pancreaticogastrostomy anastomosis from January 2010 to October 2014 were retrospectively analyzed. MP: Several surgical approaches were combined used to finish the pass-through of the neck of pancreas as the common hepatic artery, portal vein, superior mesenteric vein and splenic vein for the anatomic axis. The pancreas was transected apart from the tumor 1 cm. The proximal stump was closed by interrupted sutures after the main pancreatic duct was ligated. Dissecting the tumor-burdened pancreas and ligating the branch vessels between the splenic vessels and pancreas exactly. After identification of the distal main pancreatic duct, a stent was implanted and fixed. BPG: The reconstruction began with a mobilization of distal pancreatic stump for 3-4cm. After evaluating the size and position of pancreatic stump, a purse-string suture was preset around the sero-muscular layer of the posterior gastric wall. A small gastrostomy was performed in this area with a size equivalent to accommodate the pancreatic stump. An incision was made at the anterior gastric wall. The pancreas remnant was pulled into the gastric cavity. The purse-string, as the outer binding, was tied just enough for anastomosis and the endogastric mucosa and pancreatic capsule were interrupted sutured. The incision on the anterior gastric wall was closed with a closure device. Results: Operation was successfully performed on all patients. The mean operation time was 155 min, the mean blood loss was 300 ml and the mean postoperative length of hospital stay was 10.5 days. 6 patients had postoperative pancreatic fistula (2 were Grade B and 4 were Grade A). The follow-up range time was 3 ~ 36 months. None of the 62 patients were found to have pancreatic endocrine or exocrine insufficiency or formation of pseudo pancreatic cyst. Conclusion: Medial pancreatectomy showed trauma little, quick recovery and maximum protection the pancreatic exocrine and endocrine function which should be realized as a preferred treatment for pancreas injury and the benign or low-grade malignant tumor in neck and body of pancreas. Binding pancreaticogastrostomy anastomosis could effectively reduce the incidence of pancreatic fistula which should be a ideal reconstruction mode in medial pancreatectomy.

Objective: To investigate the clinical application of binding pancreaticogastrostomy (BPG) anastomosis in medial pancreatectomy(MP). Methods: The clinical data of 62 patients with benign and low-grade malignant lesions in neck and body of pancreas who received medial pancreatectomy combined with binding pancreaticogastrostomy anastomosis from January 2010 to October 2014 were retrospectively analyzed. MP: Several surgical approaches were combined used to finish the pass-through of the neck of pancreas as the common hepatic artery, portal vein, superior mesenteric vein and splenic vein for the anatomic axis. The pancreas was transected apart from the tumor 1 cm. The proximal stump was closed by interrupted sutures after the main pancreatic duct was ligated. Dissecting the tumor-burdened pancreas and ligating the branch vessels between the splenic vessels and pancreas exactly. After identification of the distal main pancreatic duct, a stent was implanted and fixed. BPG: The reconstruction began with a mobilization of distal pancreatic stump for 3-4cm. After evaluating the size and position of pancreatic stump, a purse-string suture was preset around the sero-muscular layer of the posterior gastric wall. A small gastrostomy was performed in this area with a size equivalent to accommodate the pancreatic stump. An incision was made at the anterior gastric wall. The pancreas remnant was pulled into the gastric cavity. The purse-string, as the outer binding, was tied just enough for anastomosis and the endogastric mucosa and pancreatic capsule were interrupted sutured. The incision on the anterior gastric wall was closed with a closure device. Results: Operation was successfully performed on all patients. The mean operation time was 155 min, the mean blood loss was 300 ml and the mean postoperative length of hospital stay was 10.5 days. 6 patients had postoperative pancreatic fistula (2 were Grade B and 4 were Grade A). The follow-up range time was 3 ~ 36 months. None of the 62 patients were found to have pancreatic endocrine or exocrine insufficiency or formation of pseudo pancreatic cyst. Conclusion: Medial pancreatectomy showed trauma little, quick recovery and maximum protection the pancreatic exocrine and endocrine function which should be realized as a preferred treatment for pancreas injury and the benign or low-grade malignant tumor in neck and body of pancreas. Binding pancreaticogastrostomy anastomosis could effectively reduce the incidence of pancreatic fistula which should be a ideal reconstruction mode in medial pancreatectomy.

A 12-year-old girl was admitted as an emergency with blunt pancreatic trauma. Computed tomography (CT) showed an intact pancreas. She failed conservative treatment. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated division of the pancreatic duct at the neck of pancreas. At laparotomy, however, there was complete necrosis of the pancreatic head. She recovered well following enteric drainage of the body of pancreas. CT and ERCP are considered the optimal imaging for pancreatic trauma but the findings may be misleading.