Whipple’s Subtotal Stomach Preserving Pancreaticoduodenectomy by the SMA first Approach
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 12
Abstract
Periampullary tumours consist of adenocarcinoma of the head, neck and uncinate process of the pancreas, ampulla, distal common bile duct and ampullary duodenum.(1) Pancreaticoduodenectomy since its initial description in 1935 by Whipple et al and with its various modifications henceforth, is the standard surgical treatment for the malignancies described above. In 2006,Pessaux et al described the “SMA first approach” of pancreaticoduodenectomy which includes the dissection of the origin of the superior mesenteric artery first, thus saving the surgeons from reaching a point of no return in cases of involvement of superior mesenteric artery in classical pancreaticoduodenectomy.(2) Subtotal stomach preserving pancreaticoduodenectomy was described in the 1990s in Japan. It involves division of the stomach 3-4 cm proximal to the pylorus, thus retaining much of the body of the stomach. We report the case of a 35 year old lady who presented to the emergency with obstructive jaundice. On evaluation CEMR with MRCP showed narrowing in the terminal CBD with wall thickening and upstream biliary dilatation without a definite conclusion. The total bilirubin level remained static for almost 3 weeks. The Endoscopy report was inconclusive. We decided to proceed with Whipple’s pancreaticoduodenectomy by the “SMA first approach” and Subtotal stomach preserving Pancreaticoduodenectomy. The patient recovered well without any major complication and was discharged on the 14th post operative day
Authors and Affiliations
Sharma S
Keywords
Related Articles
- EP ID EP521248
- DOI -
- Views 71
- Downloads 0
Diagnostic Perplexity: Right Atrial Mass
The differential diagnoses of intracardiac masses include vegetation, thrombus or tumors. Presenting clinical features along with its characteristics; size, shape, location, mobility and attachment of the mass, help diff...
A Rare Case of Carcinoma Oesophagus in 16 Year Old Male Patient Nutritional Deficiency
Esophageal carcinoma is commonly seen in elderly. Most common etiological factors are environment related with constant long term exposure of carcinogens. Hence, it is rarely seen in younger age groups (<18 years).Till d...
Spirometric Assessment of Pulmonary Function in Non Smoker Patients of Coronary Artery Disease and/or Hypertension and Comparison with Healthy Subjects
Coronary artery disease and hypertension are major health problems in today’s world. Recently lot of interest has been generated regarding the possible systemic and pulmonary effects of the pervasive low grade inflammati...
Histopathological spectrum of ovarian lesions in tertiary care institute of central India
Introduction: The ovarian pathology is currently among the widest and most complex problems in modern gynecology mainly through ovarian tumours. Its mortality rate exceeds the combined mortality of both endometrium and c...
Concomitant Esotropias- An Analytical Study
Purpose: To report the incidence of various clinical types, predisposing factors and associations of concomitant esotropias. Design: Prospective randomized population based study. Materials & Methodology: 100 patients wh...