Pancreatic neuroendocrine tumour resection in circumportal pancreas: a rare anatomical anomaly with important surgical implications

BMJ Case Rep. 2024 Mar 19;17(3):e257013. doi: 10.1136/bcr-2023-257013.

Abstract

Various congenital anomalies of the pancreas have been reported due to its complex embryological development involving the fusion of two separate buds. Circumportal pancreas is a rare anatomical anomaly where the pancreatic head and uncinate process fuse abnormally with the pancreatic body, encasing the portal vein and/or superior mesenteric vein completely. This anomaly poses several challenges to hepatobiliary surgeons, as the encasement of the portal vein by the abnormal pancreatic tissue makes an additional parenchymal transection necessary. Vascular variants have also been reported with circumportal pancreas, which, if not recognised preoperatively, can be catastrophic. Therefore, careful preoperative evaluation and planning are essential, to ensure safe pancreatic resection and recovery in a patient with circumportal pancreas. We present a case of a successful subtotal pancreatectomy and splenectomy in a patient with circumportal pancreas, for a suspected pancreatic duct adenocarcinoma. The aim of this case report is to contribute valuable insights that can aid hepatobiliary surgeons in enhancing their preoperative planning when encountered with patients with similar anatomical variances.

Keywords: general surgery; pancreas and biliary tract.

Publication types

  • Case Reports

MeSH terms

  • Humans
  • Neuroendocrine Tumors* / diagnostic imaging
  • Neuroendocrine Tumors* / surgery
  • Pancreas / abnormalities
  • Pancreas / diagnostic imaging
  • Pancreas / surgery
  • Pancreatectomy
  • Pancreatic Neoplasms* / diagnostic imaging
  • Pancreatic Neoplasms* / surgery
  • Portal Vein / abnormalities
  • Portal Vein / diagnostic imaging
  • Portal Vein / surgery