TOTAL PANCREATO-DUODENECTOMY – CORRECT INDICATION? CASE REPORT
St.Georgescu ¹, L.Dubei ¹, C.Cârdei ¹, Raluca Anton ¹, Felicia Crumpei¹,Cristina Cijevschi-Prelipcean², D. Negru³, I. Stratan⁴
1 First Surgical Clinic, 2 Institute of Gastroenterology Iasi,
3 Clinic of Radiology, 4 Intensive Care Unit
„St. Spiridon” University Hospital Iasi
University of Medicine and Pharmacy „Gr.T. Popa” Iasi
Jurnalul de chirurgie 2006; 2 (1):61-67
Full text: PDF Format (Romanian)

Abstract:

Pylorus preserving total duodenopancreatectomy (TDPpp) has a high degree of difficulty especially due to the vascular rapports of the pancreas and to the postoperative management of the diabetus and pancreatic exocrine insufficiency.

We present a patient, 48 yo., which was admitted in the First Surgical Clinic Iaşi, for epigastric pain, jaundice, nauseas, vomiting and weight loss. High level of the ASAT, ALAT and serum bilirubin was also present. Barium meal revealed a tumour localised on the second segment of the duodenum with partial stenosis.

The upper digestive endoscopy showed a prominent papilla magna (like a tutor of the Vater’s ampula). The trans-duodenal endoscopic biopsy was not performed. CT scan described a tumour localised to of the pancreatic head and a dilatation of the Wirsung duct. The preoperative diagnosis was tumour of the pancreatic head, with suspicion of malignancy.

An exploratory laparotomy was performed; preoperative histological exam can’t exclude the malignancy. That why, we decide a pylorus preserving pancreatico-duodenectomy. The severe injury of the spleno-mezenteric vein during the dessection of the pancreatic head, determined the pylorus preserving total pancreato-duodenectomy with splenectomy.

The postoperative course was complicated with delayed gastric emptying, postoperative site infection and diabetes. Postoperative histopatological exam revealed a chronic pancreatitis. After 3 months the patient has a postoperative diabetes and exocrine pancreatic deficiency treated with enzimes and insuline.

KEYWORDS: PANCREATIC TUMOR, CHRONIC PANCREATITIS, PYLORUS PRESERVING TOTAL PANCREATO- DUODENECTOMY

Correspondence:  Şt.O. Georgescu, MD, PhD, Professor of Surgery, First Surgical Clinic, „St. Spiridon” University Hospital Iaşi, 700111, Independenţei Str, no. 1, Iaşi, Romania; e-mail:

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