Abstract
Portal annular pancreas (PAP) is a rare variant in which the uncinate process of the pancreas extends and fuses with the pancreatic body via the dorsal side of the portal vein (PV). Patients with PAP alone are generally asymptomatic, but careful consideration of this anomaly during pancreatic head surgery is required. We experienced a case of a 60-year-old man with PAP who underwent pancreaticoduodenectomy (PD) for the diagnosis of pancreas head cancer. Intraoperatively, we could not identify the main pancreatic duct after cutting the pancreas above the PV, and we confirmed the existence of the pancreatic substance at the posterior side of the PV with subsequent continuous fusion with the pancreatic body, including the main pancreatic duct. At that time, we noted the PAP. PD required some difficulty to make the cut surface of the remnant pancreas body to make pancreatojejunostomy feasible. The posterior side of the PAP was resected as close as possible to the site of fusion. Despite these efforts, a grade B pancreatic fistula occurred. Thus, it is important to confirm the anatomy of the pancreas in detail to ensure safe pancreatic head surgery.
