Shumpei Satoi

Cystic Nonfunctioning Pancreatic Endocrine Neoplasm Presenting Communication with Main Pancreatic Duct

nication between the main pancreatic duct and cystic tumor ( fig. 2 ). Under the diagnosis of mucinous cystic neoplasm, distal pancreatectomy was performed. Immunohistochemical examination showed positivity for the neuroendocrine markers (chromogranin A, neuron-specific enolase, and synaptophysin). The patient remained well 9 months after the operation. A 57-year-old woman was suspected of having a pancreatic tumor by ultrasonography at medical checkup. She was asymptomatic and laboratory data, including tumor markers, were normal. Abdominal computed tomography demonstrated a cystic tumor (about 3 cm in diameter) in the pancreatic tail. The solid lesion of the tumor was enhanced with contrast material ( fig. 1 ). Endoscopic retrograde pancreatography revealed commuPublished online: January 20, 2009

Pancreaticogastrostomy Prevents Postoperative Pancreatic Fistula of Portal Annular Pancreas During Pancreaticoduodenectomy

Portal annular pancreas (PAP) is an asymptomatic congenital pancreatic anomaly in which the uncinate process of the pancreas extends and fuses to the dorsal surface of the body of the pancreas by surrounding the portal vein and or the superior mesenteric vein. During pancreaticoduonectomy (PD), the presence of PAP significantly increased risk for postoperative pancreatic fistula (POPF) because specific management of 2 pancreatic resection planes with 1 or 2 pancreatic ducts is required for pancreatico-intestinal reconstruction. To reduce the risk of POPF, a shift of the resection plain to the left for 1 anastomosis is recommended. We report a case of PAP that was successfully performed PD with pancreaticogastrostomy (PG). PG was conducted with invagination of the 2 resected pancreatic planes together into the stomach to minimize resected volume of the pancreas. A 78-year-old male patient with PAP underwent PD due to a duodenal adenocarcinoma. Intraoperatively, the uncinate process extended extensively beh...