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1.
Yoshida T Ninomiya S Morii Y Matsumata T Arimura E Hidaka H 《Hepato-gastroenterology》2004,51(58):1196-1197
We report a pancreaticojejunostomy with double duct-to-mucosa anastomotic technique after pyloruspreserving pancreaticoduodenectomy for chronic pancreatitis with bifid pancreatic duct. A 49-year-old Japanese man was diagnosed preoperatively as having chronic pancreatitis with common bile duct stricture and pseudocyst of the pancreatic head. In a pancreaticoduodenectomy, the main pancreatic duct (7mm in diameter) and a secondary pancreatic duct (4mm in diameter) were identified intraoperatively at the transected surface. Pancreatography showed the main pancreatic duct as well as thesecondary pancreatic duct that drained the remaining dorsal pancreas, allowing us to diagnose bifid pancreatic duct. The pancreaticojejunostomy was performed in an end-to-side manner to create double duct-to-mucosa anastomoses and to approximate the pancreatic parenchyma and jejunal seromuscular layers. Although bifid pancreatic duct is a rare anatomical anomaly, it behooves every surgeon who performs pancreatic resections to be aware of this entity and the techniques for dealing with it. 相似文献
2.
Tajiri T Tate G Inagaki T Kunimura T Inoue K Mitsuya T Yoshiba M Morohoshi T 《Journal of gastroenterology》2004,39(2):181-187
A 56-year-old woman who had undergone excision of the gallbladder because of a choledochal cyst had a tumorous lesion of the pancreas identified by upper abdominal ultrasonography, but an operation was not carried out, because there was no apparent increase in the cystic mass and no elevation of serum tumor markers. In October 2001, she was admitted to our hospital to check for malignancy because of elevated levels of the tumor marker Dupan-2. Abdominal enhanced computed tomography and upper abdominal ultrasonography revealed a large multilocular cystic mass in the body to tail of the pancreas. Endoscopic retrograde cholangiopancreatography showed elongation of the common duct that communicates with the common bile duct and the main pancreatic duct, indicating an anomalous arrangement of the biliary and pancreatic duct system. No apparent communications between the cystic mass and the main pancreatic duct were observed. In January 2002, the patient underwent a spleen-preserving distal pancreatectomy, and histopathological and immunohistochemical examinations led to the diagnosis of pancreatic mucinous cystadenoma with ovarian-like stroma. The mucinous cystadenoma was detected 17 years after the operation for the choledochal cyst. To the best of our knowledge, no documented case reports of mucinous cystadenoma of the pancreas associated with a choledocal cyst have been reported to date. We present here the first case report of pancreatic mucinous cystadenoma occurring in the body to tail of the pancreas, associated with a choledocal cyst. 相似文献
3.
Nobuhiko Ueda M.D. Nobuki Takahashi Hideo Yamasaki Kazunori Hirano Kazuhiko Ueda Shigeru Yoshida Mikio Tanino Toshifumi Gabata 《Journal of gastroenterology》1992,27(5):675-682
An intrasplenic psudocyst associated with the acute relapsing phase of chronic pancreatitis in a 51-year-old woman is reported,
with a review of the Japanese literature. The patient was admitted with a complaint of left lateral and back pain. Abdominal
US and CT revealed communicating cysts at the pancreatic tail and the subcapsule of the spleen. A repeat US and CT 1 month
after admission demonstrated enlargement of the cyst at the pancreatic tail. ERCP revealed a dilated main pancreatic duct
without any definite evidence of stenosis, and direct communication with the cyst at the pancreatic tail. Percutaneous cystography
revealed that the subcapsular cyst of the spleen, the cyst of the pancreatic tail, and the main pancreatic duct communicated
with each other. The cyst contained serous fluid with an amylase content of 57,500 IU/I. Distal pancreatectomy and splenectomy
was performed. Histologically, there was a nonepithelial lining on the inner surface of the cysts at the pancreatic tail and
the subcapsule of the spleen. Severe chronic inflammatory changes were present in the resected tail of the pancreas. Timely
surgical treatment is advocated to reduce the mortality and morbidity associated with complications of intrasplenic pseudocysts. 相似文献
4.
Chun-Tao Wu Wen-Yan Xu Liang Liu Jiang Long Jin Xu Quan-Xing Ni Chen Liu Xian-Jun Yu 《Hepatobiliary & pancreatic diseases international : HBPD INT》2013,12(6):651-655
Pancreatic fistula is one of the most common complications after the distal pancreatectomy. Many methods have been tried to solve the problem, but no one is optimal, especially for the soft pancreatic stump cases. This study used ligamentum teres hepatis as a patch to cover the pancreatic stump. Between October 2010 and December 2012, seventy-seven patients who had undergone distal pancreatectomy with a soft pancreatic stump were divided into two groups: group A (n=39, patients received conventional ligated main pancreatic duct method) and group B (n=38, patients underwent a coverage procedure). Patients in group A had a longer recovery from postoperative pancreatic fistula than those in group B (16.4±3.5 vs 10.8±1.6 days, P<0.05). The coverage procedure with ligamentum teres hepatis is a safe, effective and convenient method for patients with a soft pancreas remnant during distal pancreatectomy. 相似文献
5.
Koji Yamaguchi Shuji Shimizu Kazunori Yokohata Hirokazu Noshiro Kazuo Chijiiwa Masao Tanaka 《Journal of hepato-biliary-pancreatic sciences》1999,6(1):69-73
Two patients with intraductal papillary-mucinous adenoma of the pancreas were successfully treated by ductal branch-oriented minimal pancreatectomy. We propose this novel less invasive ductal branch-oriented pancreatectomy, as indicated for benign ductal ectasia of the pancreas. The cystically dilated branch duct is identified by intraoperative ultrasonography, intraoperative balloon pancreatography, and injection of indigocarmine into the cyst. The cystically dilated branch is resected from the surrounding pancreas together with minimal removal of the pancreatic parenchyma. The communicating duct and cutting margins are tightly ligated to prevent pancreatic juice leakage and fistula. A drainage tube is placed in the main pancreatic duct whenever possible. Histopathologic examination of the transected branch duct is necessary to check for mucosal extension of dysplastic epithelium. This ductal branch-oriented minimal pancreatectomy is the least invasive pancreatectomy and a suitable operation for branch-type ductal ectasia of the pancreas, which is usually benign. 相似文献
6.
Shigeki Hikida Teruo Sakamoto Kensaku Higaki Hirofumi Hata Kanetaka Maeshiro Kenji Yamauchi Yuusuke Norman Kimura Noriko Egawa Hiroyoshi Mizote Kazuo Shirouzu 《Journal of hepato-biliary-pancreatic sciences》2004,11(4):272-275
We report a case of pancreatic injury, caused by a stab wound, in which ductal injury and wound depth were clearly identified by intraoperative ultrasonography. A 65-year-old woman was emergently admitted to our hospital after stabbing herself in the abdomen in a suicide attempt. Preoperative computed tomography (CT) and laboratory examination revealed liver and pancreatic injury with massive abdominal bleeding and free air. Operative findings included injuries of the stomach, small bowel, colon, liver, and pancreas. The pancreatic lacerations were 1?cm in length, in the body. Intraoperative ultrasonography enabled the diagnosis of a lacerated main pancreatic duct with no damage to the major vessels posterior to the pancreas. Distal pancreatectomy; simple repairs of the liver, small bowel, and stomach; exteriorization of the injured colon; cholecystostomy; gastrostomy; and jejunostomy were performed. The patient recovered and was transferred to a psychiatric hospital 87 days after surgery. In this patient, intraoperative ultrasonography was successfully used to identify the degree of injury to the pancreatic duct, as well as the depth of the stab wound. In conclusion, intraoperative ultrasonography should be routinely performed to detect main pancreatic duct injury in penetrating pancreatic trauma. 相似文献
7.
Mitsuyoshi Okazaki Isamu Makino Hirohisa Kitagawa Shinichi Nakanuma Hironori Hayashi Hisatoshi Nakagawara Tomoharu Miyashita Hidehiro Tajima Hiroyuki Takamura Tetsuo Ohta 《World journal of gastroenterology : WJG》2014,20(3):852-856
We herein report a case of anaplastic carcinoma of the pancreas with remarkable intraductal tumor growth into the main pancreatic duct.A 76-year-old male was referred to our hospital for treatment of a pancreatic tumor.Preoperative examinations revealed a poorly defined tumor in the main pancreatic duct in the body of the pancreas,accompanied with severe dilatation of the main pancreatic duct,which was diagnosed as an intraductal papillary-mucinous neoplasm.We performed distal pancreatectomy and splenectomy.The pathological examination revealed that the tumor consisted of a mixture of anaplastic carcinoma(giant cell type)and adenocarcinoma in the pancreas.There was a papillary projecting tumor composed of anaplastic carcinoma in the dilated main pancreatic duct.The patient is now receiving chemotherapy because liver metastasis was detected 12 mo after surgery.In this case,we could observe a remarkable intraductal tumor growth into the main pancreatic duct.We also discuss the pathogenesis and characteristics of this rare tumor with specific tumor growth. 相似文献
8.
Kamisawa T 《Journal of gastroenterology》2004,39(7):605-615
The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo, entering the duodenum at the minor duodenal papilla (MIP). As development progresses, the duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end. In cases of patent APD, smooth-muscle fiber bundles derived from the duodenal proper muscular tunics surround the APD. The APD shows long and short patterns on pancreatography, and ductal fusion in the two types appears to differ embryologically. Patency of the APD in control cases, as determined by dye-injection endoscopic retrograde pancreatography, was 43%. Patency of the APD may depend on duct caliber, course, and terminal shape of the APD. A patent APD may prevent acute pancreatitis by reducing the pressure in the main pancreatic duct. Pancreas divisum is a common anatomical anomaly in which the ventral and dorsal pancreatic ducts do not unite embryologically. As the majority of exocrine flow is routed through the MIP in individuals with pancreas divisum, interrelationships between poor function of the MIP and increased flow of pancreatic juice caused by alcohol or diet may increase dorsal pancreatic duct pressure and lead to the development of pancreatitis. Wire-guided minor sphincterotomy, followed by dorsal duct stenting, is recommended for acute recurrent pancreatitis associated with pancreas divisum. 相似文献
9.
Yukiko Minami Yasunori Hasuike Yutaka Takeda Toshimasa Tsujinaka 《Journal of hepato-biliary-pancreatic sciences》2008,15(3):330-333
A 50-year-old Japanese woman complained of abdominal and back pain. Ten years previously she had undergone cholecystectomy, choledochectomy, and Roux-en-Y choledochojejunostomy for gallbladder cancer associated with pancreaticobiliary maljunction without bile duct dilatation. On the present admission, ultrasonography (US) and computed tomography (CT) demonstrated a large mass, 60 mm in size, in the pancreatic tail. Endoscopic retrograde cholangiopancreatography (ERCP) showed obstruction of the main pancreatic duct in the tail of the pancreas and revealed that the pancreatic duct was joined to the bile duct 25 mm above the papilla of Vater. The patient underwent distal pancreatectomy, splenectomy, left adrenalectomy, and partial gastrectomy. Histological examination revealed moderately differentiated ductal adenocarcinoma that had invaded to the proper muscle of the stomach. Double cancer of the gallbladder and pancreas in a patient with pancreaticobiliary maljunction is rare. Although the etiology of cancer of the pancreas associated with pancreaticobiliary maljunction is unclear, we should pay close attention to the pancreas as well as the biliary tract during the long-term follow-up of patients with pancreaticobiliary maljunction after they have undergone a choledochojejunostomy. 相似文献
10.
《Pancreatology》2020,20(3):569-570
BackgroundEmbryology of the human pancreas is very complex and any alteration in its development may lead to congenital biliopancreatic malformations and anomalies not thoroughly studied in literature. We here report a case of trifurcation of the Wirsung duct, avery unusual variant of the main pancreatic duct.MethodAn 80- year-old woman underwent a magnetic resonance imaging (MRI) of the abdomen and a magnetic resonance cholangiopancreatography (MRCP) to characterize a hypoechoic lesion of the pancreas detected with ultrasonography.ResultsMRI and MRCP showed a 24-mm multicystic lesion communicating with a prominent main pancreatic duct, consistent with an intraductal papillary mucinous neoplasm, as well as an ansa pancreatica. Moreover a bifidity of the distal pancreatic duct and a further accessory duct of the body of the pancreas draining into the main pancreatic duct were identified. The pancreatic tail presented normal size and morphology on axial imaging. This anomaly, not reported yet in the literature, can be categorized as a number of a duplication anomaly, in which the main pancreatic duct is trifurcated along its length.ConclusionCongenital anomalies of the pancreas and pancreatic duct are rare but not uncommonly detected on diagnostic imaging. MRI and MRCP are the non-invasive imaging modalities of choice for diagnosing congenital anomalies of the pancreas and the pancreatic duct. 相似文献
11.
N Ueda T Nagakawa T Ohta M Kayahara K Ueno I Konishi R Izumi I Miyazaki 《Journal of clinical gastroenterology》1992,15(2):136-141
A 58-year-old man on abdominal ultrasonography and CT had an irregularly elevated lesion at the neck of the gallbladder and a cyst of approximately 6.5 cm in diameter at the pancreatic tail. Percutaneous transhepatic cholangiography revealed a 2-cm shadow defect at the neck of the gallbladder and an irregular, translucent 30 x 12 mm lesion in the intrapancreatic bile duct. Total pancreatectomy and extended cholecystectomy with regional lymph node dissection was performed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPBD) was demonstrated by postoperative contrast radiography of resected specimen. The lesions of the gallbladder and common bile duct were papillary adenocarcinoma. In addition, papillary adenocarcinoma was limited almost entirely to the mucosal layer of the main pancreatic duct and its branches, from the junction of the common bile duct and pancreatic duct to the pancreatic tail. The three tumors were not continuous. The cyst at the pancreatic tail was a pseudocyst. This case represents synchronous cancer of the gallbladder, common bile duct, and pancreas associated with AAPBD. 相似文献
12.
13.
Hashimoto M Watanabe G Matsuda M Mori M 《Journal of gastroenterology and hepatology》2005,20(1):159-161
A 48-year-old man, who had suffered a bout of acute pancreatitis in September 2000, was found in March 2001 to have an increased concentration of serum amylase. A tumor in the pancreas body associated with stenosis and prestenotic dilatation of the main pancreatic duct was detected using imaging techniques. Distal pancreatectomy was performed under the diagnosis of pancreatic carcinoma. An intrapancreatic hematoma due to rupture of a pseudoaneurysm of the intrapancreatic artery was found in the resected specimen. This case illustrates how difficult it is to diagnose a small cancerous tumor in the pancreas and the rare presentation of this intrapancreatic pseudoaneurysm, which developed in a patient with a recent history of acute pancreatitis. 相似文献
14.
MASAJI HASHIMOTO GORO WATANABE MASAMICHI MATSUDA MASAYA MORI 《Journal of gastroenterology and hepatology》2006,20(1):159-161
A 48-year-old man, who had suffered a bout of acute pancreatitis in September 2000, was found in March 2001 to have an increased concentration of serum amylase. A tumor in the pancreas body associated with stenosis and prestenotic dilatation of the main pancreatic duct was detected using imaging techniques. Distal pancreatectomy was performed under the diagnosis of pancreatic carcinoma. An intrapancreatic hematoma due to rupture of a pseudoaneurysm of the intrapancreatic artery was found in the resected specimen. This case illustrates how difficult it is to diagnose a small cancerous tumor in the pancreas and the rare presentation of this intrapancreatic pseudoaneurysm, which developed in a patient with a recent history of acute pancreatitis. 相似文献
15.
Inferior head resection of the pancreas and cyst resection for choledochal cyst with chronic calcifying pancreatitis 总被引:2,自引:0,他引:2
Nakagohri T Konishi M Inoue K Takahashi S Tanizawa Y Kinoshita T 《Hepato-gastroenterology》2004,51(59):1504-1505
We report inferior head resection of the pancreas and cyst resection for congenital choledochal cyst with an anomalous arrangement of pancreaticobiliary duct and chronic calcifying pancreatitis. A 42-year-old man was admitted to the National Cancer Center Hospital East complaining of back pain. Contrast-enhanced computed tomography showed marked dilatation of the bile duct and multiple pancreatic stones in the main pancreatic duct. Endoscopic retrograde cholangiopancreatography demonstrated pancreatic stones in the dilated main pancreatic duct. The patient underwent cyst excision, inferior head resection of the pancreas, hepaticojejunostomy and lateral pancreaticojejunostomy. The postoperative course was uneventful. This procedure relieved the back pain. Choledochal cyst with anomalous arrangement of the pancreaticobiliary duct is frequently associated with acute pancreatitis. Inferior head resection of the pancreas removed the common channel which could be the cause of relapsing pancreatitis. Thus, inferior head resection can play a role in the management of choledochal cyst with chronic pancreatitis. 相似文献
16.
Takayuki Aimoto Eiji Uchida Yoshiharu Nakamura Akira Matsushita Akira Katsuno Kazumitsu Chou Masao Kawamoto Zenya Naito Takashi Tajiri 《Journal of hepato-biliary-pancreatic sciences》2008,15(5):549-553
A 46-year-old woman was readmitted to our hospital in August 2005 because of severe abdominal pain and nausea. Computed tomography demonstrated a huge cystic lesion in the retroperitoneal space behind the hepatoduodenal ligament and lesser peritoneal cavity. Endoscopic retrograde pancreatography revealed communication between the dilated main pancreatic duct and a pseudocyst. The condition was preoperatively diagnosed as chronic pancreatitis associated with a pseudocyst or an intraductal papillary mucinous neoplasm without mucin hypersecretion. The patient underwent a distal pancreatectomy with splenectomy. The pathologic diagnosis was multicentric pancreatic intraepithelial neoplasia (PanIN), and histological examination revealed a positive surgical margin around the remnant pancreas. Four months after the surgery, the patient underwent a total pancreatectomy. Macroscopic observation revealed diffuse fibrosis of the pancreatic parenchyma compatible with chronic pancreatitis. Histological examination revealed a constellation of noninvasive intraductal neoplasias with high-grade atypia, diffusely distributed in the small pancreatic ducts of the resected pancreas. Localized fibrosis and cystic dilation of the small ducts were detected in a lobule of exocrine glands draining into a ductule involved by PanIN lesions in the head of the pancreas. In summary, multicentric PanIN lesions are associated with lobular atrophy of the pancreatic parenchyma and chronic pancreatitis-like changes that follow. Total pancreatectomy may be recommended for patients with multicentric precursor lesions throughout the entire pancreas. 相似文献
17.
J. L. Yazquez-Iglesias J. A. Durana J. Yanez H. Rodriguez L. Garcia-Vallejo F. Arnal 《The American journal of gastroenterology》1988,83(8):876-878
We describe a previously unreported complication of pancreas divisum: severe and repeated episodes of gastrointestinal bleeding through the main pancreatic duct (hemosuccus pancreaticus) in a 34-yr-old woman over a period of 10 months. She had negative investigations, including a blank laparotomy, until an endoscopic retrograde cholangiopancreatography revealed a pancreas divisum with chronic pancreatitis and a small pseudocyst at the tail of the dorsal pancreas. During the procedure, bleeding through the papilla minor was observed coming from Santorini's duct. A corporocaudal pancreatectomy was done and the bleeding episodes have subsided. 相似文献
18.
《Pancreatology》2014,14(5):419-424
BackgroundHead dorsal pancreatectomy (HDP) is a segmental pancreatic resection, conservative variant of total dorsal pancreatectomy, applied to preserve the functional pancreatic parenchyma as an alternative to pancreaticoduodenectomy in not enucleable benign or low-grade malignant lesions. The absences of biliary and gastrointestinal resection/reconstruction are the other advantages of the technique.MethodsWe reported a case of HDP performed in a female 39-year-old patient for a neuroendocrine tumour of the dorsal portion of the pancreatic head.ResultsThe superior mesenteric vein was dissected from the pancreatic neck. The pancreas was transected at the left margin of the superior mesenteric vein. After identification and mobilisation of gastroduodenal artery and the anterior superior pancreatico-duodenal artery, the head dorsal segment was dissected stepwise from the duodenal wall toward the common bile duct plane; the dissection of the pancreatic parenchyma was completed along the anterior surface of the common bile duct. An end-to-side duct-to-mucosa pancreaticojejunostomy was performed. The main pancreatic duct in the ventral segment on the dissection parenchymal surface was ligated. With the inclusion of this case, there are a total of 3 cases involving resection of the dorsal portion of the pancreatic head reported in the literature.ConclusionHDP seems to be technically feasible and safe for not enucleable benign or low-grade malignant neoplasms involving the dorsal pancreatic head. However, due to the singularity of the indications and the few cases reported in the literature, further studies are needed to validate the technique. 相似文献
19.
Takeuchi K Tsuzuki Y Ando T Sekihara M Hara T Ishibashi Y Ohno Y Yoshikawa M Kuwano H 《Hepato-gastroenterology》2002,49(45):838-841
Intraductal papillary-mucinous carcinoma of the pancreas has been reported with increasing frequency. We report a case with intraductal papillary-mucinous carcinoma of the pancreas and discuss surgical treatment and current imaging modalities. A case with intraductal papillary-mucinous carcinoma was analyzed by radiological findings and clinical course. A 47-year-old man developed abdominal pain and nausea. Computed tomography showed a diffusely dilated main pancreatic duct. Duodenoscopy showed a patulous orifice of the pancreas with massive mucus secretion, but the pancreatic juice was not positive for malignant cells. Endoscopic retrograde cholangiopancreatography revealed a markedly dilated pancreatic duct extending from the body to the tail of the pancreas. Distal pancreatectomy was performed with splenectomy and lymph nodes dissection. Histopathological diagnosis was intraductal papillary-mucinous carcinoma. Endoscopic retrograde cholangiopancreatography is useful for diagnosing intraductal papillary mucin-producing tumors. To avoid unnecessary total pancreatectomy and preserve pancreatic function, intraoperative frozen section examination is widely available for the surgical treatment of intraductal papillary mucin-producing tumors. 相似文献
20.
Ito T Doi R Yoshizawa A Sakikubo M Nagai K Kida A Koizumi M Masui T Kawaguchi Y Manabe T Uemoto S 《Journal of hepato-biliary-pancreatic sciences》2011,18(2):241-6; discussion 246-9