Abhijit Acharya1*, Swati Das2, Vedavyas Mohapatra1 and Mihir K Mohapatra1
1Department of Surgical Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
2Department of Radiology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
An 18 year old girl presented to us with chief complaints of lump in upper abdomen since 1 year. Examination per abdomen revealed 10 cm × 10 cm firm, non-tender globular lump in the epigastrium and right hypochondrium not moving with respiration. CECT abdomen revealed a 77 mm × 78 mm × 67 mm SOL (Space Occupying Lesion) in the head of pancreas with calcification and septa with few peripancreatic nodes suggestive of Mucinous cystadenoma of the head of the pancreas. The patient underwent Whipple’s procedure. Intra-operatively a 10 cm × 10 cm tumor was found arising from head of pancreas which was abutting the portal vein, spleno-portal confluence and SMV whereas the distal part of SMV was completely encased over a length of 2 cm. The specimen was removed with en-bloc resection of the involved SMV. Venous reconstruction was done using a collateral coursing over the tumor but not infiltrated by it. By this indigenous method of reconstruction we were able to avoid use of prosthetic graft as well as dissecting a virgin site to harvest an autologous vein. The collateral in this case helped us to complete the vascular reconstruction with a single anastomosis avoiding luminal mismatch due to unequal size of PV and SMV.
Space occupying lesion; SMV; Prosthetic graft; PV
Acharya A, Das S, Mohapatra V, Mohapatra MK. An Innovative Method of Venous Reconstruction in Whipple’s Procedure. Ann Surg Case Rep. 2020; 3(2): 1032..