Тotal duodenopancreatectomy with preservation of spleen (clinical observation)

Background. It is known that if the malignant tumor process is localized in the pancreas body or tail, or the entire gland is affected, the operation standard volume is the pancreatic distal resection or total pancreatectomy with the spleenectomy. Recently, surgeons try to preserve this organ. It is proved that role of spleen in immunity is important. There are two variants for operations with the preservation of spleen. The first variant involves ligation and cutting the splenic artery and vein (Warshaw’s operation). In the second variant, the splenic artery and vein are preserved by cutting small branches of these vessels. The first variant is simpler but may lead to infarct and abscess of spleen and varicose veins of stomach.

The aim of this work is to present a clinical case of total duodenopancreatectomy with resection of the splenic artery and vein with the splenic preservation.

Material and methods. The patient admitted to the hospital with the mechanical jaundice. Percutaneous and transhepatic cholecystostomy was performed as an emergency procedure. During the examination, the ductal adenocarcinoma of the pancreas was detected. Surgery was performed. The tumor was localized mainly in the pancreas head, but the pancreatic body, tail and splenic artery were also involved. It was decided to perform the total duodenopancreatectomy with the resection of distal part of stomach. After removal of the specimen, blood supply to the spleen was carried out by short gastric vessels. Splenic infarct did not occur intraoperatively. It was decided to preserve the spleen. Intraoperatively venous full blood of gastric stump was observed.

Results. Postoperative ultrasound examination of the abdominal cavity didn’t reveal the insufficiency of blood supply of the spleen. Postoperative fibrogastroscopy didn’t show the varicose veins of the stomach one month later.

Conclusion. The case demonstrates sufficient blood supply of spleen with short gastric vessels.

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