Hiroto Akiyama

Solid-pseudopapillary tumor of the pancreatic head causing marked distal atrophy: a tumor originated posterior to the main pancreatic duct.

SummaryWe report the case of a solid-pseudopapillary tumor (SPT) of the head of the pancreas causing occlusion of the main pancreatic duct (MPD) and marked pancreatic atrophy distal to the tumor disproportionate to the tumor size. A 15-yr-old girl was diagnosed with 5-cm solid-pseudopapillary tumor of the pancreatic head with marked distal pancreatic atrophy. Endoscopic retrograde cholangiopancreatography demonstrated obstruction of the MPD in the pancreatic head. We performed a duodenum-preserving pancreatic head resection to avoid postoperative exocrine and endocrine insufficiency. The surgical specimen showed the typical gross appearance of a SPT, with only a thin rim of pancreas anterior to the tumor. We believe that this presentation results when a tumor originates posterior to the MPD. Thus, whether or not pancreatic atrophy occurs depends strongly on the anterior/posterior relationship between the enlarging tumor and the MPD. The risk of SPT causing severe pancreatic atrophy should be kept in mind to avoid irreversible pancreatic insufficiency in young females.

Transduodenal Intraductal Cannulation for Traumatic Pancreatic Head Disruption Without Primary Repair of the Pancreatic Duct. Report of a Case.

ハンドル外傷による主膵管断裂を伴った膵頭部断裂を経験した.主膵管は修復不能であったが, 経十二指腸的膵管内カテーテル挿入術が有効であったので報告する.症例は57歳男性.飲酒運転で衝突し腹部を打撲.受傷後16時間後に呼吸困難, 心窩部痛, 嘔吐のため救急車で来院した.諸検査より膵頭部損傷, 腹腔内出血, 外傷性膵炎と診断され緊急開腹術を行った.膵頭部前壁に上腸間膜静脈の露出を見る4cmの断裂があり, 主膵管は後壁がわずか燵続して6mmにわたって欠損していた.膵散損部を橋渡しさせカテーテルを挿入固定後に膵実質断裂部を縫合し, カテーテルの他端を経十二指腸的に体外に誘導留置した.術後の膵液瘻は難治であったが, 治癒後の内視鏡的逆行性膵管造影で膵管の開存は十分に保たれた, 本術式は膵の正常解剖と生理機能を温存でき, 膵挫滅が軽度で主膵管の縫合再建困難な膵頭部損傷に有効であると考えた.