Pylorus-Preserving Total Pancreatectomy for Intraductal Papillary Mucinous Neoplasm in the Setting of Previous Roux-en-Y Cystjejunostomy for Pancreatic Pseudocyst.

Background: Intraductal papillary mucinous neoplasms (IPMNs) are cystic lesions of the pancreas with malignant potential. The Sendai and Fukuoka criteria offer guidelines for surgical management of an IPMN. Presentation: A 69-year-old patient with a history of recurrent pancreatitis presented with steatorrhea and unintentional weight loss. Upon workup, he was found to have an IPMN, for which he met Sendai and Fukuoka criteria for surgical management. At the time of surgery, the patient's reported operative history was remarkable only for cholecystectomy; however, during the procedure, he was found to have a Roux-en-Y limb of jejunum attached to the head of the pancreas. Postoperative discussion with the patient and family revealed that this was likely the result of a past cystjejunostomy procedure used to drain what may have been a pancreatic pseudocyst that had developed after a bout of severe acute pancreatitis. Ultimately, the previously created Roux-en-Y limb was used in the reconstruction after specimen excision by total pancreatectomy. Conclusions: Main duct IPMNs have a high incidence of carcinoma. Those that meet Sendai and Fukuoka criteria should be surgically managed. In this study we present a case of IPMN management by total pancreatectomy with unique reconstruction using a previously created Roux-en-Y limb.