2022 Volume 55 Issue 1 Pages 49-56
A 65-year-old man was introduced to our hospital with a complaint of back pain. He had undergone several abdominal surgeries in childhood and was recognized to have a short bowel. Hyperuric acidemia, hypertension, hyperlipidemia, and chronic nephropathy were also observed. He was found to have distal cholangiocarcinoma with regional lymph node involvement on contrast-enhanced abdominal CT and was diagnosed with distal cholangiocarcinoma of Class V on bile cytology. From the standpoint of nutrition, the remnant length of the small intestine was a concern, and the influence of pancreas resection needed to be carefully evaluated. The length of the residual small intestine was measured using a Synapse Vincent system to determine the surgical indication for pancreaticoduodenectomy. After, subtotal stomach-preserving pancreaticoduodenectomy, we started mainly with central venous nutrition management from the viewpoint of digestion and absorption. After confirming improvement of intestinal function with elemental diets, eating with pancreatic enzyme administration was started. There are few reports of pancreaticoduodenectomy in a patient with a short bowel. The indication for pancreaticoduodenectomy may be feasible by careful examination of residual pancreatic function and residual small intestinal function.
