PANCREATICODUODENECTOMY WITH MESENTERIC VEIN RESECTION AND RECONSTRUCTION WITH HANDMADE PERITONEUM PATCH

Case report: S.M.P, male, 36 years old, white, without comorbidities, admitted to a university hospital in Rio de Janeiro in March 2018 due to cholestatic syndrome to be clarified. The patient underwent computed tomography, ERCP and echoendoscopy, which showed tumor on duodenal papilla topography (Vaters ampulla) and a contact of less than 180 ° between the tumor and the inferior mesenteric vein, but without ruling out a possible invasion of it. Biopsy of lesion was performed with poorly differentiated adenocarcinoma report, being indicated pancreaticoduodenectomy since neoadjuvant chemotherapy was not available at the unit. Surgical approach in April 2018, being observed in intraoperative an invasion of the superior mesenteric vein and opted for resection of the one-piece vein with the surgical specimen, reconstruction through autologous peritoneal vascular graft and locoregional heparinization without systemic heparinization. Given the soft consistency of the pancreas and the absence of Wirsungs duct dilation, was opted for single-loop reconstruction with pancreaticgastric anastomosis. Patient recovered uneventfully in the immediate postoperative period with interrupted follow-up since he returned to his hometown. Discussion: Ampullary adenocarcinoma is a rare malignancy with a higher incidence in males, the main symptom is persistent jaundice due to bile ducts obstruction and its prognosis is directly influenced by staging at the time of diagnosis. Surgical treatment is the only potentially healing and pancreaticoduodenectomy (Whipple procedure) is considered the gold standard of treatment, in despite of their high morbidity and mortality. Synthetic homologous, autologous or cryopreserved vascular graft are repair options when viewed intraoperatively invasion of the mesenteric-portal axis. In this case was opted for the use of autologous peritoneal graft which is a safe alternative, easy to prepare and use, not having the need for additional incision and specialized surgical intervention, especially in emergency situations. Final comments: The use of the peritoneum patch shows up as a safe technique, feasible and a good option for reconstruction of the mesenteric-portal axis, obtaining satisfactory results in the patient postoperative.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019