2021 Volume 36 Issue 2 Pages 128-134
A 78-year-old female presented with a tumor in the pancreatic head. A tumor in the uncinate process of the pancreas was visualized with strong contrast enhancement on computed tomography scan measuring 30mm, and diagnosed as a pancreatic neuroendocrine tumor by endoscopic ultrasound-fine needle aspiration biopsy. A pylorus preserving pancreaticoduodenectomy was performed. When the pancreatic head was dissected and transected above the portal vein, the pancreatic parenchyma was noted to be fused continuously with the pancreatic body on the left side of the portal vein, establishing the diagnosis of portal annular pancreas (PAP). The pancreas on the ventral side of the portal vein running through the main pancreatic duct was reconstructed with a conventional duct-to-mucosa pancreatico-jejunostomy and the dorsal side was divided using the linear stapler. The patient was discharged on postoperative day 17 without postoperative complications. We could not identify PAP on radiological re-evaluation. PAP is a very rare congenital anomaly, and it may be associated with an increased risk for development of a postoperative pancreatic fistula. In patients with PAP with a tumor located in the pancreatic uncinate process, it may be difficult to diagnose PAP preoperatively. The PAP anomaly must be kept in mind during pancreatic surgery.
