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 52
- Downloads 0
The Prevalence of Osteoporosis and Osteopenia in Persons above 50 Years Attending a Tertiary Care Hospital in South India
BACKGROUND: The prevalence of osteoporosis among the elderly Indian population is increasing with the increasing longetivity of age. This can predispose to osteoporotic fractures and is a major cause for morbidity and al...
Comparative Study of Westergren Method and Automated ESR Analyser (Microsed-10)
Background & Objectives: The erythrocyte sedimentation rate (ESR) is still widely used in clinical practice as an indicator of inflammation, infection, trauma, or malignant disease and several billion tests are being per...
Hair Dye Poisoning with Refractory Arrthymia & Interstitial Nephritis Rare Presentation
A 45year old female with no comorbid illness brought to emergency room with alleged history of consumption of 100ml of hair dye at 10am at her residence. She was initially treated at government hospital and brought to ou...
Metastatic Angiosarcoma of Liver: A Case Report
Angiosarcoma is a rare malignant tumour of endothelial origin with a poor prognosis; significantly, patients with intestinal angiosarcoma who survive over 1 year after diagnosis are extraordinarily rare. This article des...
Serum Calprotectin as a Non-invasive Diagnostic Marker for Spontaneous Bacterial Peritonitis in Egyptian Cirrhotic Patients
BACKGROUND and AIM: Delayed diagnosis of spontaneous bacterial peritonitis (SBP) is associated with high mortality in cirrhotic patients. Therefore, there is a need for a rapid non-invasive diagnostic tool. This work aim...