2023 Volume 38 Issue 2 Pages 158-162
A 45-year-old man diagnosed with a serous cystic neoplasm of the pancreatic body was followed. He had an unremarkable medical history. He was referred with an enlarging cyst and increasing CA19-9 level. Computed tomography scan showed a multifocal cystic lesion with a maximum diameter of 45mm in the pancreatic body and portal annular pancreas (PAP) with suprasplenic vein fusion. The CA19-9 level (reference: <37) was 12 at the beginning, but increased to 122 six months later.
Laparoscopic distal pancreatectomy was performed. The ventral and dorsal portions were separated using a stapler at the level of the portal vein. The postoperative course was uneventful, with no postoperative pancreatic fistula (POPF). PAP is often unrecognized due to its lack of clinical significance. However, it should be accurately diagnosed preoperatively because of the increased risk for of POPF. In distal pancreatectomy, it is recommended to separate the ventral and dorsal pancreas, individually, at the level of the portal vein because the post-fusion pancreas is thicker. The surgeon should be aware of the anatomical characteristics of PAP and the risks of POPF before performing a resection.
