Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report
Abstract Background There is no standard surgical method for treating pancreatic head tumors with fat replacement of the pancreatic body and tail. Total pancreatectomy procedures are usually performed to excise pancreatic head tumors and lead to endocrine function loss and subsequent development of...
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| Format: | Article |
| Language: | English |
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Japan Surgical Society
2020-06-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00894-x |
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| author | Toru Sakurai Yuichi Nagakawa Chie Takishita Hiroaki Osakabe Hitoe Nishino Masanori Akashi Naoto Okazaki Kenta Suzuki Kenji Katsumata Akihiko Tsuchida |
| author_facet | Toru Sakurai Yuichi Nagakawa Chie Takishita Hiroaki Osakabe Hitoe Nishino Masanori Akashi Naoto Okazaki Kenta Suzuki Kenji Katsumata Akihiko Tsuchida |
| author_sort | Toru Sakurai |
| collection | DOAJ |
| description | Abstract Background There is no standard surgical method for treating pancreatic head tumors with fat replacement of the pancreatic body and tail. Total pancreatectomy procedures are usually performed to excise pancreatic head tumors and lead to endocrine function loss and subsequent development of diabetes. We present a rare case where the adipose tissue was preserved during pancreaticoduodenectomy in a patient with a solid pseudopapillary neoplasm and fat-replaced pancreatic body and tail. Case presentation Contrast-enhanced computed tomography scans of a 43-year-old man revealed a tumor measuring approximately 3 cm in size with calcification in the pancreatic head. Magnetic resonance cholangiopancreatography showed that the pancreatic ducts in the body and tail were completely disrupted. Furthermore, endoscopic ultrasonography showed no pancreatic parenchyma in the body and tail of the pancreas, with disruption in the main pancreatic duct. Endoscopic ultrasonography-guided fine-needle aspiration led to the final pathological diagnosis of a solid pseudopapillary neoplasm, and laparoscopic total pancreatectomy was performed. However, intraoperative findings indicated that the tumor was located in the pancreatic head. Pancreatic parenchyma was not observed in the pancreatic body or tail, as it had been completely replaced with adipose tissue. Nevertheless, the shape of the pancreas was identifiable. Therefore, pancreaticoduodenectomy was performed to transect parenchyma at the pancreatic neck, while preserving the adipose tissue present in the pancreatic body. The main pancreatic duct could not be identified at the cut surface. Therefore, we performed modified Blumgart-style pancreaticojejunostomy to cover the cut end instead of reconstructing the pancreatic duct. The patient was discharged on postoperative day 12 without complications and is being followed-up as an outpatient. His fasting blood sugar and hemoglobin A1c levels according to the National Glycohemoglobin Standardization Program reports were within normal limits, indicating that the endocrine function (insulin secretion ability) was preserved during the 1.5 years following surgery. Conclusions In patients with pancreatic head tumors, pancreaticoduodenectomy that preserves fat-replaced pancreatic body and tail tissues can preserve postoperative endocrine function. |
| format | Article |
| id | doaj-art-1345e2fd59d0469999671b8a29616033 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-06-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-1345e2fd59d0469999671b8a296160332025-08-20T03:32:41ZengJapan Surgical SocietySurgical Case Reports2198-77932020-06-01611510.1186/s40792-020-00894-xPancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case reportToru Sakurai0Yuichi Nagakawa1Chie Takishita2Hiroaki Osakabe3Hitoe Nishino4Masanori Akashi5Naoto Okazaki6Kenta Suzuki7Kenji Katsumata8Akihiko Tsuchida9Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityDepartment of Gastrointestinal and Pediatric Surgery, Tokyo Medical UniversityAbstract Background There is no standard surgical method for treating pancreatic head tumors with fat replacement of the pancreatic body and tail. Total pancreatectomy procedures are usually performed to excise pancreatic head tumors and lead to endocrine function loss and subsequent development of diabetes. We present a rare case where the adipose tissue was preserved during pancreaticoduodenectomy in a patient with a solid pseudopapillary neoplasm and fat-replaced pancreatic body and tail. Case presentation Contrast-enhanced computed tomography scans of a 43-year-old man revealed a tumor measuring approximately 3 cm in size with calcification in the pancreatic head. Magnetic resonance cholangiopancreatography showed that the pancreatic ducts in the body and tail were completely disrupted. Furthermore, endoscopic ultrasonography showed no pancreatic parenchyma in the body and tail of the pancreas, with disruption in the main pancreatic duct. Endoscopic ultrasonography-guided fine-needle aspiration led to the final pathological diagnosis of a solid pseudopapillary neoplasm, and laparoscopic total pancreatectomy was performed. However, intraoperative findings indicated that the tumor was located in the pancreatic head. Pancreatic parenchyma was not observed in the pancreatic body or tail, as it had been completely replaced with adipose tissue. Nevertheless, the shape of the pancreas was identifiable. Therefore, pancreaticoduodenectomy was performed to transect parenchyma at the pancreatic neck, while preserving the adipose tissue present in the pancreatic body. The main pancreatic duct could not be identified at the cut surface. Therefore, we performed modified Blumgart-style pancreaticojejunostomy to cover the cut end instead of reconstructing the pancreatic duct. The patient was discharged on postoperative day 12 without complications and is being followed-up as an outpatient. His fasting blood sugar and hemoglobin A1c levels according to the National Glycohemoglobin Standardization Program reports were within normal limits, indicating that the endocrine function (insulin secretion ability) was preserved during the 1.5 years following surgery. Conclusions In patients with pancreatic head tumors, pancreaticoduodenectomy that preserves fat-replaced pancreatic body and tail tissues can preserve postoperative endocrine function.http://link.springer.com/article/10.1186/s40792-020-00894-xPancreatoduodenectomyTotal pancreatectomySolid pseudopapillary neoplasmFat-replaced pancreatic tissueAgenesis/Aplasia/Dysplasia/Hypoplasia of pancreatic body and tail |
| spellingShingle | Toru Sakurai Yuichi Nagakawa Chie Takishita Hiroaki Osakabe Hitoe Nishino Masanori Akashi Naoto Okazaki Kenta Suzuki Kenji Katsumata Akihiko Tsuchida Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report Surgical Case Reports Pancreatoduodenectomy Total pancreatectomy Solid pseudopapillary neoplasm Fat-replaced pancreatic tissue Agenesis/Aplasia/Dysplasia/Hypoplasia of pancreatic body and tail |
| title | Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report |
| title_full | Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report |
| title_fullStr | Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report |
| title_full_unstemmed | Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report |
| title_short | Pancreaticoduodenectomy for preservation of fat-replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm: a case report |
| title_sort | pancreaticoduodenectomy for preservation of fat replaced pancreatic body and tail tissue in a patient with solid pseudopapillary neoplasm a case report |
| topic | Pancreatoduodenectomy Total pancreatectomy Solid pseudopapillary neoplasm Fat-replaced pancreatic tissue Agenesis/Aplasia/Dysplasia/Hypoplasia of pancreatic body and tail |
| url | http://link.springer.com/article/10.1186/s40792-020-00894-x |
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