Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report
Abstract Background Middle segment-preserving pancreatectomy (MSPP) is an alternative to total pancreatectomy that allows for the preservation of the endocrine and exocrine functions of the pancreas. However, maintaining perfusion to the pancreatic remnant is of critical importance. We describe the...
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Japan Surgical Society
2021-12-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-021-01344-y |
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| author | Tomohiro Iguchi Norifumi Iseda Kosuke Hirose Mizuki Ninomiya Takuya Honboh Takashi Maeda Fumi Sawada Yu-ichi Tachibana Tetsuro Akashi Naotaka Sekiguchi Noriaki Sadanaga Hiroshi Matsuura |
| author_facet | Tomohiro Iguchi Norifumi Iseda Kosuke Hirose Mizuki Ninomiya Takuya Honboh Takashi Maeda Fumi Sawada Yu-ichi Tachibana Tetsuro Akashi Naotaka Sekiguchi Noriaki Sadanaga Hiroshi Matsuura |
| author_sort | Tomohiro Iguchi |
| collection | DOAJ |
| description | Abstract Background Middle segment-preserving pancreatectomy (MSPP) is an alternative to total pancreatectomy that allows for the preservation of the endocrine and exocrine functions of the pancreas. However, maintaining perfusion to the pancreatic remnant is of critical importance. We describe the first case to our knowledge in which indocyanine green (ICG) fluorescence was used to confirm perfusion to the pancreatic remnant during MSPP. Case presentation A 79-year-old man with diabetes mellitus was referred to our hospital for treatment of a pancreatic tumor. Computed tomography revealed a hypovascular mass in the uncus of the pancreas and dilatation of the main pancreatic duct, measuring 13 mm in the tail of the pancreas. He was diagnosed with cancer of the pancreatic uncus via endoscopic ultrasound and fine-needle aspiration revealed a mixed-type intraductal papillary mucinous neoplasm (IPMN), along with high-risk stigmata in the tail of the pancreas. We performed MSPP and the length of the pancreatic remnant was 4.6 cm. The dorsal pancreatic artery was preserved and perfusion to the pancreatic remnant was confirmed by ICG fluorescence. Histopathological examination showed a pancreatic ductal adenocarcinoma in the uncus (pT1cN1M0, pStage 2B) and IPMN in the tail of the pancreas. The postoperative course was complicated by a grade B pancreatic fistula, but this was successfully treated with conservative management. The patient was transferred to a hospital 33 days after surgery. Insulin administration was necessary, but C-peptide was detectable and blood glucose was relatively well-controlled. He did not exhibit any exocrine dysfunction when pancreatic enzyme supplementation was administered. Conclusion ICG fluorescence can be used to evaluate perfusion to the pancreatic remnant during MSPP. |
| format | Article |
| id | doaj-art-e5068ac9a4d74fc3bf3261f8a7e840ed |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-e5068ac9a4d74fc3bf3261f8a7e840ed2025-08-20T02:51:43ZengJapan Surgical SocietySurgical Case Reports2198-77932021-12-01711710.1186/s40792-021-01344-yIndocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case reportTomohiro Iguchi0Norifumi Iseda1Kosuke Hirose2Mizuki Ninomiya3Takuya Honboh4Takashi Maeda5Fumi Sawada6Yu-ichi Tachibana7Tetsuro Akashi8Naotaka Sekiguchi9Noriaki Sadanaga10Hiroshi Matsuura11Department of Surgery, Saiseikai Fukuoka General HospitalDepartment of Surgery, Saiseikai Fukuoka General HospitalDepartment of Surgery, Saiseikai Fukuoka General HospitalDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery, Saiseikai Fukuoka General HospitalDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Internal Medicine, Saiseikai Fukuoka General HospitalDepartment of Internal Medicine, Saiseikai Fukuoka General HospitalDepartment of Internal Medicine, Saiseikai Fukuoka General HospitalDepartment of Internal Medicine, Saiseikai Fukuoka General HospitalDepartment of Surgery, Saiseikai Fukuoka General HospitalDepartment of Surgery, Saiseikai Fukuoka General HospitalAbstract Background Middle segment-preserving pancreatectomy (MSPP) is an alternative to total pancreatectomy that allows for the preservation of the endocrine and exocrine functions of the pancreas. However, maintaining perfusion to the pancreatic remnant is of critical importance. We describe the first case to our knowledge in which indocyanine green (ICG) fluorescence was used to confirm perfusion to the pancreatic remnant during MSPP. Case presentation A 79-year-old man with diabetes mellitus was referred to our hospital for treatment of a pancreatic tumor. Computed tomography revealed a hypovascular mass in the uncus of the pancreas and dilatation of the main pancreatic duct, measuring 13 mm in the tail of the pancreas. He was diagnosed with cancer of the pancreatic uncus via endoscopic ultrasound and fine-needle aspiration revealed a mixed-type intraductal papillary mucinous neoplasm (IPMN), along with high-risk stigmata in the tail of the pancreas. We performed MSPP and the length of the pancreatic remnant was 4.6 cm. The dorsal pancreatic artery was preserved and perfusion to the pancreatic remnant was confirmed by ICG fluorescence. Histopathological examination showed a pancreatic ductal adenocarcinoma in the uncus (pT1cN1M0, pStage 2B) and IPMN in the tail of the pancreas. The postoperative course was complicated by a grade B pancreatic fistula, but this was successfully treated with conservative management. The patient was transferred to a hospital 33 days after surgery. Insulin administration was necessary, but C-peptide was detectable and blood glucose was relatively well-controlled. He did not exhibit any exocrine dysfunction when pancreatic enzyme supplementation was administered. Conclusion ICG fluorescence can be used to evaluate perfusion to the pancreatic remnant during MSPP.https://doi.org/10.1186/s40792-021-01344-yMiddle segment-preserving pancreatectomyIndocyanine green fluorescenceBlood supplyPancreatic ductal adenocarcinomaIntraductal papillary mucinous neoplasm |
| spellingShingle | Tomohiro Iguchi Norifumi Iseda Kosuke Hirose Mizuki Ninomiya Takuya Honboh Takashi Maeda Fumi Sawada Yu-ichi Tachibana Tetsuro Akashi Naotaka Sekiguchi Noriaki Sadanaga Hiroshi Matsuura Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report Surgical Case Reports Middle segment-preserving pancreatectomy Indocyanine green fluorescence Blood supply Pancreatic ductal adenocarcinoma Intraductal papillary mucinous neoplasm |
| title | Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report |
| title_full | Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report |
| title_fullStr | Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report |
| title_full_unstemmed | Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report |
| title_short | Indocyanine green fluorescence to ensure perfusion in middle segment-preserving pancreatectomy: a case report |
| title_sort | indocyanine green fluorescence to ensure perfusion in middle segment preserving pancreatectomy a case report |
| topic | Middle segment-preserving pancreatectomy Indocyanine green fluorescence Blood supply Pancreatic ductal adenocarcinoma Intraductal papillary mucinous neoplasm |
| url | https://doi.org/10.1186/s40792-021-01344-y |
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