Mikulić D, Bubalo T, Mrzljak A, Škrtić A, Jadrijević S, Kanižaj TF, Kocman B. Role of total pancreatectomy in the treatment of paraduodenal pancreatitis: A case report. World J Gastrointest Surg 2019; 11(6): 296-302 [PMID: 31367277 DOI: 10.4240/wjgs.v11.i6.296]
Corresponding Author of This Article
Danko Mikulić, MD, PhD, FEBS, Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zajčeva 19, Zagreb 10000, Croatia. danko.mikulic@zg.t-com.hr
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Danko Mikulić, Tomislav Bubalo, Stipislav Jadrijević, Branislav Kocman - Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia
Anna Mrzljak, Tajana Filipec Kanižaj - Division of Gastroenterology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb 10000, Croatia
Anita Škrtić, Department of Pathology and Cytology, University of Zagreb, School of Medicine, University Hospital Merkur, Zagreb 10000, Croatia
Author contributions: Mikulić D and Bubalo T were the patient’s operator and assistant. Mikulić D reviewed the literature and contributed to manuscript drafting. Bubalo T contributed to manuscript drafting. Mrzljak A reviewed the literature and contributed to manuscript drafting. Škrtić A performed pathology analyzed and explained the pathology imagings findings. Jadrijević S, Filipec Kanižaj T and Kocman B were responsible for the revision of the manuscript for important intellectual content. All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Danko Mikulić, MD, PhD, FEBS, Division of Abdominal Surgery and Organ Transplantation, Department of Surgery, University Hospital Merkur, Zajčeva 19, Zagreb 10000, Croatia. danko.mikulic@zg.t-com.hr
Received: April 17, 2019 Peer-review started: April 18, 2019 First decision: May 31, 2019 Revised: June 6, 2019 Accepted: June 21, 2019 Article in press: June 21, 2019 Published online: June 27, 2019
Abstract
BACKGROUND
Paraduodenal pancreatitis (PP) is a rare form of chronic pancreatitis presenting with symptoms of duodenal obstruction. Conservative treatment is often unsuccessful and pancreaticoduodenectomy is the preferred surgical approach. A mini review of the outcomes of surgical therapy for PP shows that the results of pancreaticoduodenectomy are predominantly favorable.
CASE SUMMARY
In our case report of PP, we describe an unusual course first presenting with the symptoms of chronic pancreatitis and a pseudocyst of the pancreatic tail. A pseudocystojejunostomy was performed and the late postoperative course was complicated with the symptoms of duodenal obstruction. At laparotomy, PP was found and the patient was treated with a total pancreatectomy. The postoperative course was uneventful and good weight gain with resolution of pain was demonstrated at follow up visits.
CONCLUSION
Surgery is currently the optimal treatment option for PP. It is also the best diagnostic tool in distinguishing between pancreatitis and pancreatic adenocarcinoma.
Core tip: Paraduodenal pancreatitis (PP) is a rare form of chronic pancreatitis presenting with symptoms of duodenal obstruction. Conservative treatment is often unsuccessful and pancreaticoduodenectomy is the preferred surgical approach. Differential diagnosis from carcinoma of the pancreatic head can be quite difficult and it is often only postoperative pathology that provides the definitive diagnosis. In this case report we present an uncommon case where PP was associated with a necrotic pseudocyst of the tail of the pancreas and the patient was treated with total pancreatectomy.
