A Case of Remnant Pancreatic Carcinoma after Pancreatoduodenectomy for Bile Duct Carcinoma

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  • 下部胆管癌に対する亜全胃温存膵頭十二指腸切除後残膵癌の1例
  • 症例 下部胆管癌に対する亜全胃温存膵頭十二指腸切除後残膵癌の1例
  • ショウレイ カブ タンカン ガン ニ タイスル アゼン イ オンゾンスイトウ ジュウニシチョウ セツジョ ゴザンスイガン ノ 1レイ

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Abstract

<p>We performed distal pancreatectomy with preservation of the pancreatic body for carcinoma of the remnant pancreas which was diagnosed 4 years and 8 months after pancreatoduodenectomy for bile duct carcinoma. The patient was a 75-year-old man undergone pancreatoduodenectomy for carcinoma of the inferior bile duct which was pathologically diagnosed as well-differentiated tubular adenocarcinoma Stage II. Four years and 8 months later, an increase in the CA19-9 level was noted. An abdominal CT scan showed a 2-cm poorly enhanced irregular-shaped tumor at the remnant pancreatic tail. The main pancreatic duct had dilated, and a granular shadow which seemed to be a pancreatic stone was confirmed in the main pancreatic duct in the vicinity of the pancreatojejunostomy. Pancreatic carcinoma in the remnant pancreas and chronic pancreatitis due to the pancreatic stone were diagnosed, and we performed distal pancreatectomy with preservation of the pancreatic body, splenectomy and lymph node dissection. At surgery, the jejunum was dissected and lifted at the distal aspect of the gastrojejunostomy, and jejunal anastomosis was made at the distal pancreatic stump as a drainage of the pancreatic duct for recurrent pancreatitis. The histopathological diagnosis was tubular adenocarcinoma Stage IB. After the operation, his blood-sugar level has been kept stable without using insulin. As metachronous remnant pancreatic carcinoma after resection of bile duct carcinoma is extremely rare, we present this case with some bibliographical comments.</p>

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