Abstract
We report a case of pancreatic carcinoma in the pancreaticogastrostomy site after pylorus-preserving pancreatoduodenectomy (PPPD). A 57-year-old man who had undergone PPPD for intraductal papillary mucinous neoplasm (IPMN) of the pancreatic head 11 years before was admitted to our hospital for surgical treatment of gastric carcinoma at the pancreaticogastrostomy site. Reconstruction after the PPPD had been done by pacreaticogastrostomy, end-end duodenojejunostomy, and end-side choledochojejunostomy. The histopathological diagnosis had been papillary adenoma. We performed en bloc resection of the distal stomach, the remnant pancreas 3 cm from the junction of the pancreaticogastrostomy and a small part of the transverse colon, then reconstructed using Whipple's procedure. Histopathological examination showed moderately differentiated tubular adenocarcinoma of the remnant pancreas. Metachronous carcinogenesis in the pancreaticogastrostomy site after PPPD for IPMN is rare, and a very careful follow-up is necessary for a long period after the first operation.
