Circumportal Pancreas - A Rare Case (original) (raw)
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Portal Annular Pancreas: Case Report of a Rare Anomaly
Cureus
Portal annular pancreas is a rare congenital anomaly in which the portal vein and/or the splenoportal confluence are completely encircled by aberrant pancreatic parenchyma. It is an asymptomatic condition and is usually an incidental finding. It is, however, important to a surgeon because the postoperative pancreatic fistula (POPF) rates following pancreatic resection are higher in patients with this anomaly. A 47-year-old male presented with features of obstructive jaundice. He was diagnosed to have periampullary carcinoma, and pancreatoduodenectomy was planned. During surgery, uncinate process was seen extending posterior to the portal vein and was communicating with the body of pancreas to the left of the portal vein. After transection, there were two pancreatic stumps. The pancreatic duct was identified in the stump anterior to the portal vein. No duct was present in the posterior pancreatic stump. We closed the posterior pancreatic stump with interrupted polypropylene sutures and performed a duct to mucosa pancreaticojejunostomy in the anterior stump. On reviewing the preoperative computed tomography (CT) scan, we were able to identify the pancreatic tissue encasing the portal vein superior to the splenic vein. Circumportal pancreas is classified based on the orientation of pancreatic duct to the portal vein and the relationship of the aberrant pancreatic tissue with the splenoportal confluence. Following pancreatoduodenectomy, the surgeon has to manage two pancreatic stumps, one anterior and the other posterior to the portal vein. No standardised technique has been described for management of the pancreatic stumps. Every surgeon planning pancreatic surgery should be aware of this rare anomaly, and look for the same in the preoperative CT scan so that appropriate plan can be made regarding the type of pancreatic anastomosis.
Surgery, 2009
PORTAL ANNULAR PANCREAS (PAP) is a pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein. To the best of our knowledge, there have only been 3 reports of PAP in the literature. 1-3 During pancreatic resection, the presence of a PAP significantly affects the procedure, including the pancreaticointestinal reconstruction. Thus, it is important to recognize a PAP preoperatively; however, the frequency and characteristics of the anomaly have yet to be precisely determined. Our experience of technical difficulty during a pancreaticoduodenectomy in a patient with a PAP and distal bile duct adenocarcinoma led us to determine the frequency of PAP and its morphologic features. To this end, we reviewed abdominal contrast-enhanced multidetector computed tomographies (MDCTs) to determine the incidence of PAP. . The 700
Langenbeck's Archives of Surgery, 2007
Background Due to the complex embryologic development, pancreatic anatomy can be very variable. Discussion The authors present the second ever reported case in the literature of a complete pancreatic encasement of the portal vein which forced us to alter the standard operative procedure of pancreatic head resection, thus enabling possible dangerous complications.
Retroportal main pancreatic duct with circumportal pancreas: radiographic visualization
Clinical Imaging, 2011
Purpose: The aim of this study was to investigate the imaging findings of retroportal main pancreatic duct (RMPD), a rare anomaly of the pancreas, and circumportal pancreas (CP) on computed tomography (CT) and magnetic resonance (MR) imaging. We also reviewed the previous literature and discussed its best imaging method, etiology and clinical importance. Methods: This work is a retrospective study. Two cases of RMPD were enrolled. The imaging findings of RMPD and CP were reviewed among the various CT and MR images obtained. Differences in visualization among the scans were evaluated using a four-stage model. Results: RMPD was always accompanied by CP. RMPD was detectable on contrast-enhanced CT but not on noncontrasted CT. RMPD was shown most clearly on arterial, portal and late phases of contrast-enhanced CT, contrast-enhanced fat-suppressed T1-weighted images and fat-suppressed T2-weighted images. CP was much easier to detect than RMPD and could be identified even on noncontrasted images. Conclusions: We described the fourth and the fifth reported cases of RMPD. This is the first study to describe its MR imaging findings. CP was always present in cases of RMPD and was easily detectable on tomographic images. When radiologists or surgeons notice CP, it is necessary to pay attention to the course of the main pancreatic duct, particularly preoperatively to avoid surgical complications. It should be noted that these anomalies are undetectable on projection images.
Portal Annular Pancreas: A Rare and Overlooked Anomaly
Polish Journal of Radiology, 2017
Portal annular pancreas is a rare pancreatic developmental anomaly which is often overlooked at imaging, and often diagnosed retrospectively when it is detected incidentally at the time of surgery. Although the anomaly itself is asymptomatic, it becomes important in cases where pancreatic resection/anastomosis is planned, because of varying ductal anatomy, risk of ductal injury and increased risk of postoperative pancreatic fistula formation.
A Classic Case of Annular Pancreas and its Clinical Implications
International Journal of Morphology, 2011
Annular pancreas is a rare developmental anomaly where the head of the pancreas surrounds the second part of the duodenum like a ring. This may cause the duodenal constriction, obstruction, peptic ulcers and other complications. We saw a classic case of annular pancreas. The head of pancreas surrounded the second part of duodenum completely. However there was no narrowing of the duodenum. The case may be of importance for gastroenterologists, surgeons and radiologists.
A rare congenital anomaly of the pancreas: a cadaveric case report
2013
Context The pancreas is formed by ventral and dorsal pancreatic buds which arise from the endodermal lining of the gut. When the duodenum rotates to the right, the ventral pancreatic bud migrates dorsally and finally come and lie below the dorsal pancreatic bud. The developmental errors in the rotation of these components lead to annular pancreas. Case report We report a rare type of the incomplete annular pancreas around the contents of right free margin of lesser omentum. There was an extra pancreatic mass situated horizontally immediately above the superior border of the pancreas, situated behind the lesser omentum. The right end of this mass extended into the epiploic foramen and incompletely encircled the portal vein, bile duct and hepatic artery proper from behind. The left end of the extra pancreatic mass was extended towards the lesser curvature of the stomach. Further, this mass completely surrounded the origin of three branches of the celiac trunk. Its right end was found to be continuous with the head of the pancreas, close to the pylorus. Histology of the extra pancreatic mass revealed the presence of normal pancreatic tissue. Conclusion preoperative diagnosis of this rare anomaly is of clinical importance during surgeries involving the contents of right free margin of lesser omentum and epiploic foramen.
Portal annular pancreas: the pancreatic duct ring sign on MRCP
Radiology Case Reports, 2015
Portal annular pancreas is a rare pancreatic variant in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein. It is asymptomatic, but it can be mistaken for a pancreatic head mass on imaging and could also have serious consequences during pancreatic surgery, if unrecognized. We report this case of a 53-year-old female patient who was diagnosed to have portal annular pancreas on the basis of an unusual course (ring appearance) of the main pancreatic duct on magnetic resonance cholangiopancreatography, not described earlier in the radiology literature.
Pancreaticoduodenectomy in portal annular pancreas: report of a case
Surgery Today, 2012
Portal annular pancreas (PAP) is a rare anatomical anomaly in which the pancreatic parenchyma surrounds the superior mesenteric vein and portal vein (PV) annularly. This anomaly requires careful consideration in pancreatic resection. A case is presented and the technical issues are discussed. A 61-year-old female was referred to the hospital for suspected papilla Vater adenocarcinoma. Preoperative computed tomography showed that the PV was annularly surrounded by pancreatic parenchyma. Surgery revealed the uncinate process extended extensively behind the PV and fused with the pancreatic body. The pancreas was first divided above the PV, and it was divided again in the body after liberating the PV from pancreatic annulation. The postoperative course was uneventful without pancreatic fistula. It is safer to divide the pancreatic body on the left of the fusion between the uncinate process and the pancreatic body to reduce the risk of pancreatic fistula in pancreaticoduodenectomy for PAP.