Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report
Abstract Background Pancreatic head resection following proximal gastrectomy jeopardizes the blood flow of the remnant stomach owing to right gastroepiploic conduit sacrifice, thereby necessitating total gastrectomy. However, owing to its high invasiveness, concomitant remnant total gastrectomy with...
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Japan Surgical Society
2023-06-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-023-01700-0 |
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| author | Masaru Matsumura Masahiro Kobayashi Satoshi Okubo Shusuke Haruta Rikako Koyama Hironori Uruga Junichi Shindoh Tsunao Imamura Yutaka Takazawa Masaji Hashimoto |
| author_facet | Masaru Matsumura Masahiro Kobayashi Satoshi Okubo Shusuke Haruta Rikako Koyama Hironori Uruga Junichi Shindoh Tsunao Imamura Yutaka Takazawa Masaji Hashimoto |
| author_sort | Masaru Matsumura |
| collection | DOAJ |
| description | Abstract Background Pancreatic head resection following proximal gastrectomy jeopardizes the blood flow of the remnant stomach owing to right gastroepiploic conduit sacrifice, thereby necessitating total gastrectomy. However, owing to its high invasiveness, concomitant remnant total gastrectomy with pancreatectomy should be avoided as much as possible. Herein, we describe our experience of total pancreatectomy with right gastroepiploic conduit preservation in a patient with a history of proximal gastrectomy and reconstruction by jejunum interposition. Case presentation A 78-year-old woman with a history of gastric cancer was followed up at our institute for multiple intraductal papillary mucinous neoplasm, and main pancreatic duct stricture in the pancreatic head was newly detected. The cystic lesion was extended to the pancreatic body. Proximal gastrectomy and reconstruction by jejunal interposition were previously performed, and the mesenteric stalk of the interposed jejunum was approached through the retrocolic route. We planned total pancreatectomy with right gastroepiploic conduit preservation. Following adhesiolysis, the interposed jejunum and its mesentery lying in front of the pancreas were isolated. The arterial arcade from the common hepatic artery to the right gastroepiploic artery was detached from the pancreas. Furthermore, the right gastroepiploic vein was isolated from the pancreas. The pancreatic body and tail were pulled up in front of the remnant stomach, and the splenic artery and vein were resected. The pancreatic body and tail were pulled out to the right side, and the pancreatic head was divided from the pancreatic nerve plexus to the portal vein. The jejunal limb for entero-biliary anastomosis was passed through the hole behind the superior mesenteric artery and vein, and gastrointestinal anastomosis using the antecolic route and Braun anastomosis were performed. Conclusions To avoid remnant total gastrectomy, right gastroepiploic conduit preservation is an optional procedure for pancreatic head resection in patients who have undergone proximal gastrectomy with reconstruction by jejunal interposition. |
| format | Article |
| id | doaj-art-a17ed64cc4f74f0a8d2f9bff050b04f4 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-a17ed64cc4f74f0a8d2f9bff050b04f42025-08-20T03:35:51ZengJapan Surgical SocietySurgical Case Reports2198-77932023-06-01911910.1186/s40792-023-01700-0Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case reportMasaru Matsumura0Masahiro Kobayashi1Satoshi Okubo2Shusuke Haruta3Rikako Koyama4Hironori Uruga5Junichi Shindoh6Tsunao Imamura7Yutaka Takazawa8Masaji Hashimoto9Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon HospitalHepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon HospitalHepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon HospitalDepartment of Gastroenterological Surgery, Toranomon HospitalDepartment of Gastroenterology, Toranomon HospitalDepartment of Diagnostic Pathology, Toranomon HospitalHepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon HospitalDepartment of Gastroenterology, Toranomon HospitalDepartment of Diagnostic Pathology, Toranomon HospitalHepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon HospitalAbstract Background Pancreatic head resection following proximal gastrectomy jeopardizes the blood flow of the remnant stomach owing to right gastroepiploic conduit sacrifice, thereby necessitating total gastrectomy. However, owing to its high invasiveness, concomitant remnant total gastrectomy with pancreatectomy should be avoided as much as possible. Herein, we describe our experience of total pancreatectomy with right gastroepiploic conduit preservation in a patient with a history of proximal gastrectomy and reconstruction by jejunum interposition. Case presentation A 78-year-old woman with a history of gastric cancer was followed up at our institute for multiple intraductal papillary mucinous neoplasm, and main pancreatic duct stricture in the pancreatic head was newly detected. The cystic lesion was extended to the pancreatic body. Proximal gastrectomy and reconstruction by jejunal interposition were previously performed, and the mesenteric stalk of the interposed jejunum was approached through the retrocolic route. We planned total pancreatectomy with right gastroepiploic conduit preservation. Following adhesiolysis, the interposed jejunum and its mesentery lying in front of the pancreas were isolated. The arterial arcade from the common hepatic artery to the right gastroepiploic artery was detached from the pancreas. Furthermore, the right gastroepiploic vein was isolated from the pancreas. The pancreatic body and tail were pulled up in front of the remnant stomach, and the splenic artery and vein were resected. The pancreatic body and tail were pulled out to the right side, and the pancreatic head was divided from the pancreatic nerve plexus to the portal vein. The jejunal limb for entero-biliary anastomosis was passed through the hole behind the superior mesenteric artery and vein, and gastrointestinal anastomosis using the antecolic route and Braun anastomosis were performed. Conclusions To avoid remnant total gastrectomy, right gastroepiploic conduit preservation is an optional procedure for pancreatic head resection in patients who have undergone proximal gastrectomy with reconstruction by jejunal interposition.https://doi.org/10.1186/s40792-023-01700-0Pancreatic resectionProximal gastrectomyRight gastroepiploic arteryRight gastroepiploic vein |
| spellingShingle | Masaru Matsumura Masahiro Kobayashi Satoshi Okubo Shusuke Haruta Rikako Koyama Hironori Uruga Junichi Shindoh Tsunao Imamura Yutaka Takazawa Masaji Hashimoto Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report Surgical Case Reports Pancreatic resection Proximal gastrectomy Right gastroepiploic artery Right gastroepiploic vein |
| title | Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report |
| title_full | Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report |
| title_fullStr | Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report |
| title_full_unstemmed | Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report |
| title_short | Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report |
| title_sort | total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation a case report |
| topic | Pancreatic resection Proximal gastrectomy Right gastroepiploic artery Right gastroepiploic vein |
| url | https://doi.org/10.1186/s40792-023-01700-0 |
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