Abstract
An 83-year-old woman with abdominal pain and liver dysfunction was referred to our hospital. Examinations revealed a bile duct carcinoma, and pancreaticoduodenectomy was performed. When the pancreatic head was dissected from the portal vein, we discovered that the uncinate process of the pancreas extended to the left behind the portal vein and that it fused continuously with the pancreatic body on the left side of the portal vein. We re-evaluated the preoperative computed tomography scan and found that this anomaly had been detectable. Therefore, we diagnosed this case as portal annular pancreas. A single pancreatic duct was observed and it ran through the pancreas on the ventral side of the portal vein. We dissected the pancreas and transected its body to the left side of the fusion part. This procedure made it possible to perform the usual anastomosis between the pancreas and jejunum. Postoperatively, pancreatic fistula developed but improved in response to conservative management. When pancreaticoduodenectomy is performed for patients with portal annular pancreas, we need to consider surgical procedures including transection and reconstruction of the pancreas. However, as similar reports are extremely rare, the standard operating procedure is not established. Here, we report our case with a review of the relevant literature.
