Management of Pancreatectomy for Pancreatic Cancer in a Patient With Annular Portal Pancreas: A Case Report

Portal annular pancreas (PAP) is one of the rare pancreatic anomalies in which the pancreatic parenchyma surrounds the portal vein (PV) or superior mesenteric vein (SMV), accounting for only around a few proportions of all patients. PAP is thought to be associated with the high risk of postoperative pancreatic fistula (POPF) after pancreatectomy. We describe our experience of a case with PAP and review the literature on pancreatectomy in patients with PAP. A 72-year-old male presented to our department with a pancreatic body mass with a history of previous abdominal surgeries, who underwent distal pancreatectomy (DP) with lymphadenectomy following neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel. PAP was identified during surgery, which was not found in computed tomography scans and other modalities in the previous examinations. The annular pancreas was resected using tri-staplers with polyglycolic acid (PGA) sheets. His postoperative course was uneventful without POPF, and he was discharged on postoperative day 11. In conclusion, when PAP is suspected in patients with pancreatic cancer, understanding the accurate anatomy of the pancreas is essential to determine the surgical technique and a suitable choice of device for the transection of pancreatic parenchyma for reducing POPF.