Portal Annular Pancreas - An Underreported and Unexpected Intraop Catastrophe - Review of Anatomy, Classification and Management

Rohith Mudadla, Jeswanth Satyanesan, Satish Devakumar K, Amudhan A, Harshit Kamal, Selvaraj T

Abstract: Portal annular pancreas (PAP) is an anatomic variation due to aberrant fusion of uncinate process of the pancreas which arises from the ventral bud and extends to fuse with thedorsal pancreatic bud by encircling the portal vein or superior mesenteric vein. In this article, we present a case report in a 59 year old male who presented with obstructive jaundice and features of G. O. O and diagnosed as having moderately differentiated adenocarcinoma on endoscopic biopsy from second part of duodenum. He was planned for an elective whipples procedure, during pancreatic transection tuft of pancreatic tissue encircling the portal vein and SMV axis and joining the body of pancreas posteriorly was present. Portal annular pancreatic anomaly was identified intraoperatively. The retroportal tissue was soft in consistency and suture ligated with 3-0 prolene. Post operatively there was no POPF but developed ascites which was resolved spontaneously and discharged on post op day 13.

Keywords: PAP, portal annular pancreas, G. O. O., Gastric outlet obstruction