A Robotic Pancreaticoduodenectomy Case Involving a Meandering Main Pancreatic Duct Coursing Posterior to a Replaced Common Hepatic Artery and in Front of the Portal Vein.

IF 0.7 Q4 SURGERY
Surgical Case Reports Pub Date : 2025-01-01 Epub Date: 2025-03-21 DOI:10.70352/scrj.cr.24-0184
Yui Sawa, Yosuke Inoue, Kosuke Kobayashi, Atsushi Oba, Yoshihiro Ono, Hiromichi Ito, Yu Takahashi
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Abstract

Introduction: Anatomical anomalies, such as branches of the celiac artery and superior mesenteric artery (SMA), and pancreatic malformations, including the annular pancreas, are important during pancreaticoduodenectomy (PD). Here, we report a case of an anomaly of the artery and main pancreatic duct (MPD) in which the pancreatic parenchyma surrounded the replaced common hepatic artery (rCHA), and the meandering main pancreatic duct (MMPD) ran behind the rCHA.

Case presentation: A 71-year-old woman was diagnosed with intraductal papillary mucinous neoplasm (IPMN) of pancreatic body and the dilation of MPD to 13 mm, which was a factor of high-risk stigmata. Preoperative computed tomography (CT) showed that the rCHA branched from the superior mesenteric artery (SMA) and the pancreatic parenchyma surrounded the rCHA. Moreover, the MPD meandered and ran behind the rCHA. PD was performed. At the time of dissection between the rCHA and pancreatic parenchyma, we had to divide not only the cranial part of the pancreatic parenchyma along the rCHA but also the MPD. The postoperative course was uneventful.

Conclusion: This is the first report of the rCHA surrounded by pancreatic parenchyma and MMPD running behind the rCHA and in front of the portal vein.

机器人胰十二指肠切除术一例,涉及蜿蜒的主胰管在置换的肝总动脉后方和门静脉前方。
解剖异常,如腹腔动脉和肠系膜上动脉(SMA)分支,胰腺畸形,包括环状胰腺,在胰十二指肠切除术(PD)中是重要的。在此,我们报告一例动脉和主胰管(MPD)异常,其中胰腺实质包围了替换的肝总动脉(rCHA),而弯曲的主胰管(MMPD)在rCHA后面。病例介绍:一位71岁的女性被诊断为胰腺体导管内乳头状粘液瘤(IPMN), MPD扩张至13 mm,这是一个高危因素。术前CT显示rCHA从肠系膜上动脉(SMA)分支,胰腺实质包围rCHA。此外,MPD还走在rCHA的后面。行PD。在分离rCHA和胰腺实质时,我们不仅要沿着rCHA分割胰腺实质的颅部,还要沿着MPD分割。术后过程平淡无奇。结论:本病例为首次报道rCHA被胰腺实质包围,MMPD位于rCHA后方和门静脉前方。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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审稿时长
13 weeks
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