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ANZ Journal of Surgery Jul 2021The aim of this report is to present our experience of the last 5 years with repairs of congenital annular pancreas in neonates to determine the efficacy and outcomes...
BACKGROUND
The aim of this report is to present our experience of the last 5 years with repairs of congenital annular pancreas in neonates to determine the efficacy and outcomes of laparoscopic side-to-side duodenoduodenostomy compared to laparoscopic diamond-shaped anastomosis.
METHODS
A total of 35 patients with congenital annular pancreas in neonates were operated by laparoscopic procedure at our hospital during January 2015 and September 2020. Twenty patients underwent laparoscopic side-to-side duodenoduodenostomy (group A), and 15 patients of the control group underwent laparoscopic diamond-shaped anastomosis (group B). The clinical data between the two groups were compared.
RESULTS
The operative time is 77.5 ± 18.7 min in group A (range 50 ~ 125 min), and 92.5 ± 20.2 min in group B (range 75-155 min) (P = 0.029). Feedings started on postoperative day 4.5 ± 0.9 (range 3-6 days) in group A, whereas 6.5 ± 0.8 (range 4-7 days) in group B (P = 0.013). The cases in group A were discharged uneventfully in a mean of 9.2 ± 2.3 (range 7-15 days) postoperative day, and 11.4 ± 3.7 days (range 8-20 days) in group B (P = 0.041). The cases of group A have been followed up for 33.1 ± 15.4 months (range 3-60 months), group B had been followed up for 32.0 ± 14.0 months (range 6-55 months) (P > 0.05), and all the cases were doing well at the last follow-up examination.
CONCLUSION
Laparoscopic side-to-side duodenoduodenostomy is beneficial to the recovery of intestinal function postoperatively in the neonate with annular pancreas.
Topics: Anastomosis, Surgical; Humans; Infant, Newborn; Laparoscopy; Pancreas; Pancreatic Diseases; Retrospective Studies; Treatment Outcome
PubMed: 34013592
DOI: 10.1111/ans.16959 -
Fetal and Pediatric Pathology Aug 2022The presence of hepatic parenchyma at ectopic locations is infrequently reported in neonatal age. A male neonate presented with clinical signs and symptoms of duodenal...
The presence of hepatic parenchyma at ectopic locations is infrequently reported in neonatal age. A male neonate presented with clinical signs and symptoms of duodenal obstruction. At exploration, an annular pancreas was found as the causative factor and he underwent a Kimura's duodeno-duodenostomy. A pedicled cyst was attached to the stomach's greater curvature, was excised, and histologically was a mesothelial-lined cyst with ectopic liver, complete with bile ducts, in the cyst wall. Ectopic liver tissue may be clinically silent and found within the wall of a mesothelial cyst. Long-term complications of this ectopic tissue are not known.
Topics: Cysts; Duodenal Obstruction; Duodenostomy; Humans; Infant, Newborn; Liver; Male; Pancreas
PubMed: 33945385
DOI: 10.1080/15513815.2021.1919809 -
Pancreas Apr 2021Portal annular pancreas (PAP) is a rare congenital pancreatic anomaly, in which the uncinate process of the pancreas fuses to the body of pancreas behind the portal... (Review)
Review
Portal annular pancreas (PAP) is a rare congenital pancreatic anomaly, in which the uncinate process of the pancreas fuses to the body of pancreas behind the portal vein. Here, we report a case of PAP with common hepatic arterial anomaly, which was identified during surgery. A 57-year-old man who had branch type intraductal papillary mucinous neoplasm in the head of the pancreas developed a nodule in the cystic lesion. We planned pylorus preserving pancreaticoduodenectomy. The common hepatic artery from the celiac artery passing behind the portal vein was revealed in preoperative examinations. During surgery, we discovered that the uncinate process of the pancreas was fused with the body of the pancreas behind the portal vein. We divided the pancreas at the anterior and posterior of the portal vein. The main pancreatic duct was present in the anterior pancreatic stump. We performed pancreaticojejunostomy in the anterior stump and closed the posterior stump by interrupted suture. Forty-four surgical cases of PAP have been reported in the English medical literature. There are few previous reports of PAP which involved an arterial anomaly. Clinicians should consider PAP preoperatively to ensure that the surgeon can appropriately plan pancreatic resection to avoid postoperative complications.
Topics: Hepatic Artery; Humans; Male; Middle Aged; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreaticoduodenectomy; Portal Vein
PubMed: 33939680
DOI: 10.1097/MPA.0000000000001766 -
Journal of Surgical Case Reports Apr 2021Annular pancreas is defined by a ring of pancreatic tissue encircling the descending portion of the duodenum. It is exceptionally rare in adults and commonly diagnosed...
Annular pancreas is defined by a ring of pancreatic tissue encircling the descending portion of the duodenum. It is exceptionally rare in adults and commonly diagnosed during the investigation of symptoms arising due to its complications. Treatment usually involves the surgical correction with a duodenoduodenostomy, gastrojejunostomy or duodenojejunostomy. We discuss the case of a 66-year-old male patient who presented with symptoms of gastric outlet obstruction and was found to have an annular pancreas encircling the pylorus and the first and second portions of the duodenum and was treated by performing a gastrojejunostomy. Upper gastrointestinal series, computerized tomography (CT) scans, and magnetic resonance cholangeopancreatographys can all be used for preoperative diagnosis; however, endoscopic retrograde cholangiopancreatography (ERCP) is the diagnostic modality of choice. Nonetheless, many patients may only be diagnosed intraoperatively, especially those who cannot undergo an ERCP due to stenosis proximal to the duodenum or patients in whom the annulus may not be visible on CT scan.
PubMed: 33927863
DOI: 10.1093/jscr/rjab125 -
Journal of Clinical Gastroenterology Feb 2022Annular pancreas is a rare congenital condition where the second part of the duodenum is encircled by pancreatic tissue. There is a scarcity of data on its natural...
BACKGROUND AND AIMS
Annular pancreas is a rare congenital condition where the second part of the duodenum is encircled by pancreatic tissue. There is a scarcity of data on its natural history therefore, we aimed to evaluate the epidemiology of annular pancreas and identify underlying associations using a large database.
METHODS
A multi-institutional database (Explorys) was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms diagnosis of "MRI, CT, EUS and/or ERCP" between April 2015 and April 2020 was identified. Subsequently a cohort of patients with history of "annular pancreas" was identified.
RESULTS
There were a total of 40,075,980 individuals in the database with 6,162,600 (15.38%) who had an magnetic resonance imaging, computed tomography, endoscopic retrograde cholangiopancreatography, and/or endoscopic ultrasound. There were 210 (3.4/100,000) had a diagnosis of annular pancreas. When compared with the control group, patients with annular pancreas were more likely to have a history of alcohol use, smoking, acute pancreatitis, chronic pancreatitis, gastritis, duodenitis, jaundice, and gastrointestinal outlet obstruction.
CONCLUSIONS
This is the largest study evaluating the epidemiology of annular pancreas. We found the estimated prevalence rate of annular pancreas to be 3.4/100,000 in those who had abdominal imaging. Annular pancreas was more likely to be diagnosed in patients with symptoms pertaining to acute or chronic pancreatitis, biliary, and gastric outlet obstruction.
Topics: Acute Disease; Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreas; Pancreatic Diseases; Pancreatitis; United States
PubMed: 33769394
DOI: 10.1097/MCG.0000000000001531 -
Folia Morphologica 2022A unique partial anomalous pulmonary venous return in combination with other rare malformations such as annular pancreas and a persistent umbilical vein was discovered...
A unique partial anomalous pulmonary venous return in combination with other rare malformations such as annular pancreas and a persistent umbilical vein was discovered in a female Caucasian cadaver during an anatomical dissection at the Paracelsus Medical University in Nuremberg, Germany. The pulmonary anomaly comprised the aberrant left superior pulmonary vein connecting the superior lobe of the left lung with the left brachiocephalic vein resulting in a left to right shunt. An annular pancreas without any signs causing duodenal compression was additionally found. To complete the constellation of malformations, a persistent umbilical vein within the round ligament fissure of the liver was also observed, connecting to an inferior branch of the extrahepatic left ramus of the portal vein. This rare constellation of malformations has been illustrated and thoroughly discussed with the currently available literature to develop a hypothesis for the genetic and developmental background.
Topics: Cadaver; Female; Humans; Pancreas; Pancreatic Diseases; Pulmonary Veins; Scimitar Syndrome
PubMed: 33749806
DOI: 10.5603/FM.a2021.0026 -
Surgical Oncology Jun 2021A fundamental aspect of oncosurgical planning in organ resections is the identification of feeder vessel details to preserve healthy organ tissue while fully resecting...
BACKGROUND
A fundamental aspect of oncosurgical planning in organ resections is the identification of feeder vessel details to preserve healthy organ tissue while fully resecting the tumors. The purpose of this study was to determine whether three-dimensional (3D) cancer case models of computed tomography (CT) images will assist resident-level trainees in making appropriate operative plans for organ resection surgery.
METHODS
This study was based on the perception of surgery residents who were presented with 5 different oncosurgical scenarios. A five-station carousel including cases of liver mass, stomach mass, annular pancreas, pelvic mass and mediastinal mass was formed for the study. The residents were required to compare their perception level of the cases with their CT images, and 3D models in terms of identifying the invasion of the mass, making differential diagnosis and preoperative planning stage.
RESULTS
All residents have given higher scores for models. 3D models provided better understanding of oncopathological anatomy and improved surgical planning. In all scenarios, 70-80% of the residents preferred the model for preoperative planning. For surgical choice, compared to the CT, the model provided a statistically significant difference in terms of visual assessment, such as tumor location, distal or proximal organotomy (p:0.009). In the evaluation of presacral mass, the perception of model was significantly better than the CT in terms of bone-foramen relationship of chondrosarcoma, its origin, geometric shape, localization, invasion, and surgical preference (p:0.004). The model statistically significantly provided help to evaluate and prepare the case together with the colleagues performing surgery (p:0.007). Commenting on the open-ended question, they stated that the tumor-vessel relationship was clearly demonstrated in the 3D model, which has been very useful.
CONCLUSIONS
With the help of 3D printing technology in this study, it is possible to implement and evaluate a well-structured real patient scenario setup in cancer surgery training. It can be used to improve the understanding of pathoanatomical changes of multidisciplinary oncologic cases. Namely, it is used in guiding the surgical strategy and determining whether patient-specific 3D models change pre-operative planning decisions made by surgeons in complex cancer mass surgical procedures.
Topics: Humans; Imaging, Three-Dimensional; Internship and Residency; Liver Neoplasms; Mediastinal Neoplasms; Models, Anatomic; Pancreas; Pancreatic Diseases; Printing, Three-Dimensional; Sacrum; Spinal Neoplasms; Stomach Neoplasms; Surgical Oncology; Tomography, X-Ray Computed
PubMed: 33711767
DOI: 10.1016/j.suronc.2021.101537 -
Journal of Gastrointestinal Surgery :... May 2021Portal annular pancreas (PAP) is an anatomic variation due to aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein. In this article, we... (Review)
Review
INTRODUCTION
Portal annular pancreas (PAP) is an anatomic variation due to aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein. In this article, we present a case report with a systematic review of literature of patients undergoing major pancreatic surgery with associated PAP. We also intend to discuss and suggest possible surgical strategies to minimise major postoperative complications.
METHODS
A systematic literature search was conducted using the terms "circumportal," "periportal," "pancreas," "annular pancreas," "portal annular pancreas" and "pancreas anomaly." All articles describing portal annular pancreas with surgical resection were included.
RESULTS
We identified a total of 53 patients of PAP from 29 articles, who underwent pancreatic resection with a median age of 65 years. POPF (postoperative pancreatic fistula) was demonstrated in 42.55% of patients and 34% had CR (clinically relevant)-POPF. Following pancreaticoduodenectomy, pancreatic stump was reconstructed in all patients with either pancreaticojejunostomy or pancreaticogastrostomy. Standard line of pancreatic transection, i.e., division of anteportal portion at the pancreatic neck and stapling of the retroportal process, resulted in 71% incidence of CR-POPF, whereas it was only 16% when extended resection was performed to achieve single pancreatic stump and 12.5% when retroportal portion was sutured or ligated. Amongst distal pancreatic resections, 66% had POPF and 33% developed CR-POPF.
CONCLUSION
It is of utmost importance for pancreatic surgeons to diligently look for and identify PAP in the preoperative imaging. Additional imaging in the form of MRCP helps to define abnormal pancreatic ductal anatomy. Surgeons need to be cognisant of pancreatic stump management in patients with PAP to reduce associated higher rates of POPF.
Topics: Aged; Humans; Pancreas; Pancreatic Diseases; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications
PubMed: 33555524
DOI: 10.1007/s11605-021-04927-0 -
Radiology Case Reports Apr 2021Annular pancreas is a rare congenital intestinal obstruction to be found in infants. It is characterized by nonbilious vomiting, abdominal distention, and feeding...
Annular pancreas is a rare congenital intestinal obstruction to be found in infants. It is characterized by nonbilious vomiting, abdominal distention, and feeding intolerance that share similar symptoms with other intestinal obstructions. We reported a case of 11-month-old female infant with a history of nonbilious vomiting after coughing as much as 6 times per day 1 day before admission. The patient had an incorrect provisional diagnosis of hypertrophic pyloric stenosis based on ultrasound. Later on, an upper gastrointestinal series showed dilatation of the second part of the duodenum which was successfully treated by a duodenostomy during laparotomy procedure. It is suggested that treating an intestinal obstruction needs a further investigation when the symptoms were continuously repeated.
PubMed: 33537107
DOI: 10.1016/j.radcr.2021.01.019 -
Surgical and Radiologic Anatomy : SRA May 2021Annular pancreas encountered in adults and jejunal arterial variations are rare. Anatomical variations can cause conflicts between oncology and surgical safety.
PURPOSE
Annular pancreas encountered in adults and jejunal arterial variations are rare. Anatomical variations can cause conflicts between oncology and surgical safety.
METHODS
Case report of a 68-year-old man suffering from vomiting because of an annular pancreas and a ductal adenocarcinoma of the pancreas head invading the second portion of the duodenum.
RESULTS
Contrast-enhanced computed tomography showed multiple arterial variations describing the absence of the coeliac trunk such that the left gastric artery (LGA), splenic artery and superior mesenteric artery (SMA) were arising separately from the aorta. The accessory left hepatic artery arose from the LGA; and both the common hepatic artery and combined trunk of the replaced right hepatic artery with the higher replaced first jejunal artery separately arose close to the root of the SMA. The patient underwent curative pancreaticoduodenectomy which achieved 3 years of recurrence-free survival.
CONCLUSION
This was an extraordinary case of annular pancreas with first jejunal arterial variation detailing an embryological interpretation as well as considerations for balancing short- and long-term outcomes.
Topics: Aged; Carcinoma, Pancreatic Ductal; Computed Tomography Angiography; Humans; Imaging, Three-Dimensional; Male; Mesenteric Artery, Superior; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreaticoduodenectomy; Treatment Outcome
PubMed: 33481131
DOI: 10.1007/s00276-020-02671-9