Pancreaticoduodenectomy with combined superior mesenteric vein resection without reconstruction is possible: A case report and review of the literature

doi:10.12998/wjcc.v6.i8.214

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Aug 16, 2018; 6(8): 214-218
Published online Aug 16, 2018. doi: 10.12998/wjcc.v6.i8.214

Pancreaticoduodenectomy with combined superior mesenteric vein resection without reconstruction is possible: A case report and review of the literature

Lionel Jouffret, Theophile Guilbaud, Olivier Turrini, Jean-Robert Delpero

Lionel Jouffret, Theophile Guilbaud, Olivier Turrini, Jean-Robert Delpero, Department of Surgical Oncology, Institut PaoliCalmettes, Marseille 13009, France

Author contributions: Jouffret L wrote the manuscript; Guilbaud T drawn the illustration of case report; Turrini O reviewed the manuscript; Delpero JR performed the surgery.

Informed consent statement: Patient authorized publication of case report.

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Correspondence to: Lionel Jouffret, MD, Doctor, Surgical Oncologist, Department of Surgical Oncology, Institut Paoli-Calmettes, 232 Bd de Sainte Marguerite, Marseille 13009, France. jouffretl@ipc.unicancer.fr

Telephone: +33-49-1223660 Fax: +33-49-1223550

Received: March 9, 2018
Peer-review started: March 9, 2018
First decision: April 4, 2018
Revised: April 10, 2018
Accepted: June 7, 2018
Article in press: June 8, 2018
Published online: August 16, 2018
Processing time: 160 Days and 17 Hours

ARTICLE HIGHLIGHTS

Case characteristics

A 56-year-old woman with a locally advanced pancreatic adenocarcinoma (PA).

Clinical diagnosis

Febrile Jaundicy.

Laboratory diagnosis

Ca 19-9 42, cholestasis decreased after biliary stenting.

Imaging diagnosis

Computed tomography scan revealed superior mesenteric vein (SMV) thrombosis but no PV thrombosis and no contact with head PA.

Pathological diagnosis

PA with poor differentiation, lymph node metastasis (2N+/5), vascular and perineural invasion, and SMV wall infiltration. All resection margins were tumor-free.

Treatment

Pancreaduodenectomy with SMV resection without reconstruction.

Related reports

No reconstruction of this venous axis was realized after confirming adequate portal veinous, splenic, and left gastric venous flow and the absence of bowel ischemia.

Term explanation

Development of collateral flow through the inferior mesenteric and splenic veins allows ligation of the superior mesenteric venous.

Experiences and lessons

This case report showed that a short SMV resection could be achieved during pancreatoduodenectomy without venous reconstruction, when an appropriate small bowel venous outflow is ensured by inferior mesenteric vein.