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Ductal branch-oriented pancreatic resection for an intraductal papillary mucinous neoplasm in the uncinate process that caused recurrent acute pancreatitis: a case report of successful treatment

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Abstract

Acute pancreatitis reportedly occurs in about 15 % of cases of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs), with two-thirds of BD-IPMNs being located in the head or uncinate process of the pancreas. However, the surgical indications and optimal treatment methods for BD-IPMNs have not been established. A 59-year-old Japanese male with epigastralgia was admitted to our hospital. A multidetector row computed tomography (MDCT) scan disclosed grade I acute pancreatitis. Magnetic resonance cholangiopancreatography disclosed a 1.5-cm BD-IPMN in the uncinate process. Two months after discharge, the epigastralgia recurred, and MDCT again revealed grade I pancreatitis. Due to the repeated episodes of pancreatitis, we performed ductal branch-oriented pancreatic resection. To detect the inferior branch of the Wirsung duct and avoid the development of a pancreatic fistula, we injected indigo carmine into the tumor which confirmed ligation of the inferior branch. Histopathologically, the tumor proved to be an adenoma. The postoperative course was uneventful in both the short- and long-term follow-up and, to date, there has been no recurrence of pancreatitis, or diabetes mellitus during the 6 years since pancreatectomy. This procedure is one of the methods that can be used for the successful resection of a BD-IPMN in the uncinate process that caused recurrent acute pancreatitis.

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Abbreviations

IPMN:

Intraductal papillary mucinous neoplasm

MDCT:

Multidetector row computed tomography

AP:

Acute pancreatitis

PD:

Pancreaticoduodenectomy

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Disclosures

Conflict of Interest: The authors declare that they have no conflict of interest.

Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5)

Informed Consent: Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Surgery, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Funabashi, Chiba, 273-8588, Japan

    Toshiyuki Natsume, Takashi Maruyama, Hajime Tanaka, Hiroshi Matsuzaki, Akinari Miyazaki, Takumi Ohta, Yayoi Sato, Yuji Yamamoto, Mizuho Aikawa, Ryota Otsuka & Akitoshi Yanagihara

  2. Department of Internal Medicine, Funabashi Municipal Medical Center, Funabashi, Japan

    Akitoshi Kobayashi

  3. Department of Pathology, Funabashi Municipal Medical Center, Funabashi, Japan

    Shinichiro Shimizu

Authors
  1. Toshiyuki Natsume
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  2. Takashi Maruyama
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  3. Akitoshi Kobayashi
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  4. Shinichiro Shimizu
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  5. Hajime Tanaka
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  6. Hiroshi Matsuzaki
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  7. Akinari Miyazaki
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  8. Takumi Ohta
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  9. Yayoi Sato
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  10. Yuji Yamamoto
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  11. Mizuho Aikawa
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  12. Ryota Otsuka
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  13. Akitoshi Yanagihara
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Correspondence to Toshiyuki Natsume.

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Natsume, T., Maruyama, T., Kobayashi, A. et al. Ductal branch-oriented pancreatic resection for an intraductal papillary mucinous neoplasm in the uncinate process that caused recurrent acute pancreatitis: a case report of successful treatment. Clin J Gastroenterol 6, 476–479 (2013). https://doi.org/10.1007/s12328-013-0428-4

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  • DOI: https://doi.org/10.1007/s12328-013-0428-4

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