Clinical Image

Abnormal Position of Main Pancreatic Duct Running on the Posterior Surface of Pancreas, which is Possible to Influence the Result of Pancreaticoduodenectomy

Takashi Orii^*
Department of Surgery, Showa Inan General Hospital, Japan

^*Corresponding author: Takashi Orii, Department of Surgery, Showa Inan General Hospital, Akaho 3230, Komagane, Nagano 399-4117, Japan

Published: 25 Sep, 2018
Cite this article as: Orii T. Abnormal Position of Main Pancreatic Duct Running on the Posterior Surface of Pancreas, which is Possible to Influence the Result of Pancreaticoduodenectomy. World J Surg Surgical Res. 2018; 1: 1063.

Clinical Image

The success of pancreaticoduodenectomy depends on reliable pancreaticoenterostomy. Herein, we present a patient, who underwent pancreaticoduodenectomy for cholangiocarcinoma. The main pancreatic duct was shown to face superior mesenteric veinand splenic vein directly without intervention of pancreatic parenchyma (Figure 1). The pancreatic duct was exposed on the posterior surface of the pancreas, which was confirmed also in the operative view (Figure 2).
We always perform the anastomosis of the duct with a certain pancreatic parenchyma for the stability of the stitches. Because, in this case, it was impossible to do so, external stent was placed into the pancreatic duct, fixing by ligation of absorbable thread with the duct covering the stent, and was penetrated and fixed to jejunal wall by purse-string suture.
We cannot find the case with such ‘anomaly’ of position of the pancreatic duct as this patient by searching in PubMed.

Figure 1

Figure 2