CEPHALIC DUODENOPANCREATECTOMY IN THE NEONATAL PERIOD: A CASE REPORT AND REVIEW OF THE LITERATURE

Background: Pancreatic masses in the neonatal period are a rare pathology. Resection of the head of the pancreas is an exceptional surgical challenge due to the need to perform millimetric anastomosis, therefore, subsequent complications are frequent. Methods: Case report and review of published articles on cephalic duodenopancreatectomies (CDP) in patients less than 28 days-old.Case report: An 11-days-old female newborn, 3030g, consulted for apnea and cyanosis. Magnetic resonance imaging showed a cystic mass in the right hypochondrium measuring 6.2x5.9x6.4mm with suspicion of malignancy. At 22 days of life a laparotomy was performed finding a mass in the head of the pancreas firmly adhered to the extrahepatic biliary tract and duodenum. A CDP and reconstruction by gastroduodenostomy, hepatico-duodenostomy (Kasai-like) and dunking pancreato-gastrostomy were performed. The pathological anatomy described a serous cystadenoma. With 6 years of follow-up, she has presented a single episode of cholangitis, with no signs of endocrine or exocrine insufficiency. Results (Table 1): 6 patients with CDP less than 28 days have been described. The surgical technique presented many variations. Five patients presented complications, the most frequent being exocrine insufficiency.Conclusion: CDP in the neonatal period is an exceptional procedure, with only 5 other cases described in the literature. We present CDP on the largest mass described so far, with no signs of pancreatic insufficiency in a long-term follow-up.