- A 74 year old man with chronic pancreatitis was diagnosed with a neuroendocrine pseudocyst in the head and neck of the pancreas.
- A total pancreatectomy with splenectomy and right hemicolectomy was proposed, with reconstruction of the portal vein using a femoral vein panel graft.
- The tumour occluded the superior mesenteric vein, leading to development of collateral branches in and around the pancreas head.
- The tumour had also begun to invade the portal vein, which will be divided superior to the pancreas and inferior to the porta hepatis.
- The right gastric artery, gastroduodenal artery, splenic artery and arterial branches supplying the pancreas will be divided, but the celiac and main SMA were free of tumour.
- The middle and right colic arteries, and the ileocolic artery were compromised, so the right colon will be resected .
- The distal duodenum will be resected, while preserving the pylorus of the stomach, .
- The proximal jejunum will be resected, and an ileostomy will be performed.
CTs (arterial phase)
CTs (venous phase)