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Peer-reviewedCC BY 4.0Surgical Case Reports

Spiral Jejunal Reconstruction of Both Pancreatic Stumps in Type II Portal Annular Pancreas during Pancreaticoduodenectomy: A Case Report

  • Hiroto Suzuki1
  • Ken Ishikawa1
  • Takuya Bamba2
  • Masataka Nakano1
  • Yuki Inagaki1
  • Kentaro Hamada1
  • Sizuka Shoji1
  • Mitsuo Mori2
  1. 1Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai, Aichi, Japan
  2. 2Department of Surgery, Shizuoka Tokushukai, General Hospital, Shizuoka, Shizuoka, Japan
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Abstract

INTRODUCTION: Portal annular pancreas (PAP) is a rare congenital anomaly in which the uncinate process encircles the portal vein (PV) or superior mesenteric vein (SMV) and fuses with the dorsal aspect of the pancreatic body. We herein report a case of ampullary carcinoma associated with PAP treated by subtotal stomach-preserving pancreaticoduodenectomy.

CASE PRESENTATION: A 51-year-old woman presented with scleral icterus and watery diarrhea. Following a detailed examination, she was diagnosed with carcinoma of the ampulla of Vater and underwent surgical treatment. During pancreatic resection, 2 pancreatic cut surfaces were identified on the ventral and dorsal sides of the SMV, leading to the intraoperative diagnosis of PAP. A lifted jejunal limb was rotated in a spiral fashion, and pancreaticojejunostomy was performed for each pancreatic stump. The postoperative course was uneventful, with no evidence of postoperative pancreatic fistula, and the patient was discharged in good condition.

CONCLUSIONS: Although PAP is a rare anatomical anomaly, it requires careful attention during surgical procedures and reconstruction; therefore, it should be recognized preoperatively whenever possible. The reconstruction method employed in the present case may be useful as a reconstructive option for PAP because it avoids excessive pancreatic resection. We report this case with a review of the relevant literature.

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Cite

BibTeXRIS
BibTeX
@article{suzuki2026spiral,
  title = {{Spiral Jejunal Reconstruction of Both Pancreatic Stumps in Type II Portal Annular Pancreas during Pancreaticoduodenectomy: A Case Report}},
  author = {Hiroto Suzuki and Ken Ishikawa and Takuya Bamba and Masataka Nakano and Yuki Inagaki and Kentaro Hamada and Sizuka Shoji and Mitsuo Mori},
  journal = {Surgical Case Reports},
  year = {2026},
  month = oct,
  doi = {10.70352/scrj.cr.26-0511},
  url = {https://doi.org/10.70352/scrj.cr.26-0511},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Spiral Jejunal Reconstruction of Both Pancreatic Stumps in Type II Portal Annular Pancreas during Pancreaticoduodenectomy: A Case Report
AU  - Hiroto Suzuki
AU  - Ken Ishikawa
AU  - Takuya Bamba
AU  - Masataka Nakano
AU  - Yuki Inagaki
AU  - Kentaro Hamada
AU  - Sizuka Shoji
AU  - Mitsuo Mori
PY  - 2026
DA  - 2026/10/31
JO  - Surgical Case Reports
DO  - 10.70352/scrj.cr.26-0511
UR  - https://doi.org/10.70352/scrj.cr.26-0511
AB  - INTRODUCTION: Portal annular pancreas (PAP) is a rare congenital anomaly in which the uncinate process encircles the portal vein (PV) or superior mesenteric vein (SMV) and fuses with the dorsal aspect of the pancreatic body. We herein report a case of ampullary carcinoma associated with PAP treated by subtotal stomach-preserving pancreaticoduodenectomy.  CASE PRESENTATION: A 51-year-old woman presented with scleral icterus and watery diarrhea. Following a detailed examination, she was diagnosed with carcinoma of the ampulla of Vater and underwent surgical treatment. During pancreatic resection, 2 pancreatic cut surfaces were identified on the ventral and dorsal sides of the SMV, leading to the intraoperative diagnosis of PAP. A lifted jejunal limb was rotated in a spiral fashion, and pancreaticojejunostomy was performed for each pancreatic stump. The postoperative course was uneventful, with no evidence of postoperative pancreatic fistula, and the patient was discharged in good condition.  CONCLUSIONS: Although PAP is a rare anatomical anomaly, it requires careful attention during surgical procedures and reconstruction; therefore, it should be recognized preoperatively whenever possible. The reconstruction method employed in the present case may be useful as a reconstructive option for PAP because it avoids excessive pancreatic resection. We report this case with a review of the relevant literature.
SN  - 2198-7793
ER  -