Autoimmune Pancreatitis Undergoing Gastroduodenal Artery-preserving Pancreaticoduodenectomy Following a Subtotal Esophagectomy

Abstract

We report a case of autoimmune pancreatitis for which a pancreaticoduodenectomy was performed, while preserving the gastroduodenal artery, following a prior subtotal esophagectomy and reconstruction via a gastric tube. A 70-year-old man, who had undergone subtotal esophagectomy and reconstruction via a gastric tube for esophageal cancer 35 months previously, was admitted to our hospital for jaundice. Upon admission, abdominal CT showed a 23-mm pancreatic tumor in the pancreatic head with obstructive jaundice. The serum IgG4 concentration was low, and the levels of the tumor markers Elastase 1, DUPAN 2, and CA19-9 were high. We diagnosed pancreatic cancer. Angiography showed no invasion of the right gastroepiploic artery via the gastroduodenal artery. We performed a pancreaticoduodenectomy, preserving the gastroduodenal artery. Pathological examination revealed typical autoimmune pancreatitis with no malignant cells. In cases of low serum IgG4 concentration, it is difficult to diagnose AIP without the findings of the main pancreatic duct.