Gastric volvulus with perforation 1 year after total pancreatectomy: a case report
Abstract Background Because of its rare indication and relatively simple reconstruction procedure (only choledochojejunostomy and gastrojejunostomy) compared to those for pancreatoduodenectomy, the technical tips and pitfalls of total pancreatectomy are rarely discussed. Herein, we discuss a rare ca...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-04-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00840-x |
| _version_ | 1811222293553086464 |
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| author | Yusuke Takahashi Hitoshi Seki |
| author_facet | Yusuke Takahashi Hitoshi Seki |
| author_sort | Yusuke Takahashi |
| collection | DOAJ |
| description | Abstract Background Because of its rare indication and relatively simple reconstruction procedure (only choledochojejunostomy and gastrojejunostomy) compared to those for pancreatoduodenectomy, the technical tips and pitfalls of total pancreatectomy are rarely discussed. Herein, we discuss a rare case of gastric volvulus 1 year after total pancreatectomy and provide advice to prevent such cases. Case presentation A 66-year-old woman underwent total pancreatectomy with splenectomy for mixed-type intraductal papillary mucinous neoplasm of the pancreas. Choledochojejunostomy (retro-colic route) and gastrojejunostomy (ante-colic route, Billroth II method) were performed for reconstruction. The final diagnosis was mixed-type intraductal papillary mucinous adenoma of the pancreas without malignant neoplasm. She had no clinical symptoms, such as abdominal pain and fever, during postoperative follow-up. However, at 1 year postoperatively, she complained of abdominal pain. Contrast-enhanced abdominal computed tomography showed volvulus and perforation of the stomach. Emergent surgery was performed. The stomach fornix was located on the right side and was partly perforated. We resected the perforation site with a linear cutter® (New Type Linear Cutter, Ethicon, USA) and released the gastric volvulus. Moreover, we fixed the stomach to the left abdominal wall using non-absorbable thread. The cause of the perforation was clinically and pathologically unclear. Her serum albumin and cholinesterase levels temporarily decreased postoperatively, but gradually increased. A recurrence of volvulus-related symptoms has not been observed. Conclusions After total pancreatectomy with splenectomy, although the stomach is connected with the jejunum, it is typically fixed only by the pedicle of the left gastric artery and vein. In the present case, this anatomical change may have been a cause of the gastric volvulus. Thus, it might be better to fix the remnant stomach in total pancreatectomy with splenectomy. |
| first_indexed | 2024-04-12T08:13:17Z |
| format | Article |
| id | doaj.art-5dbcf534e95c4efa917baa46a4f4405d |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-04-12T08:13:17Z |
| publishDate | 2020-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-5dbcf534e95c4efa917baa46a4f4405d2022-12-22T03:40:52ZengSpringerOpenSurgical Case Reports2198-77932020-04-01611510.1186/s40792-020-00840-xGastric volvulus with perforation 1 year after total pancreatectomy: a case reportYusuke Takahashi0Hitoshi Seki1Department of Hepatobiliary Pancreatic Surgery, Nagano Municipal HospitalDepartment of Hepatobiliary Pancreatic Surgery, Nagano Municipal HospitalAbstract Background Because of its rare indication and relatively simple reconstruction procedure (only choledochojejunostomy and gastrojejunostomy) compared to those for pancreatoduodenectomy, the technical tips and pitfalls of total pancreatectomy are rarely discussed. Herein, we discuss a rare case of gastric volvulus 1 year after total pancreatectomy and provide advice to prevent such cases. Case presentation A 66-year-old woman underwent total pancreatectomy with splenectomy for mixed-type intraductal papillary mucinous neoplasm of the pancreas. Choledochojejunostomy (retro-colic route) and gastrojejunostomy (ante-colic route, Billroth II method) were performed for reconstruction. The final diagnosis was mixed-type intraductal papillary mucinous adenoma of the pancreas without malignant neoplasm. She had no clinical symptoms, such as abdominal pain and fever, during postoperative follow-up. However, at 1 year postoperatively, she complained of abdominal pain. Contrast-enhanced abdominal computed tomography showed volvulus and perforation of the stomach. Emergent surgery was performed. The stomach fornix was located on the right side and was partly perforated. We resected the perforation site with a linear cutter® (New Type Linear Cutter, Ethicon, USA) and released the gastric volvulus. Moreover, we fixed the stomach to the left abdominal wall using non-absorbable thread. The cause of the perforation was clinically and pathologically unclear. Her serum albumin and cholinesterase levels temporarily decreased postoperatively, but gradually increased. A recurrence of volvulus-related symptoms has not been observed. Conclusions After total pancreatectomy with splenectomy, although the stomach is connected with the jejunum, it is typically fixed only by the pedicle of the left gastric artery and vein. In the present case, this anatomical change may have been a cause of the gastric volvulus. Thus, it might be better to fix the remnant stomach in total pancreatectomy with splenectomy.http://link.springer.com/article/10.1186/s40792-020-00840-xPancreatic intraductal neoplasmsPancreatectomyStomach volvulus |
| spellingShingle | Yusuke Takahashi Hitoshi Seki Gastric volvulus with perforation 1 year after total pancreatectomy: a case report Surgical Case Reports Pancreatic intraductal neoplasms Pancreatectomy Stomach volvulus |
| title | Gastric volvulus with perforation 1 year after total pancreatectomy: a case report |
| title_full | Gastric volvulus with perforation 1 year after total pancreatectomy: a case report |
| title_fullStr | Gastric volvulus with perforation 1 year after total pancreatectomy: a case report |
| title_full_unstemmed | Gastric volvulus with perforation 1 year after total pancreatectomy: a case report |
| title_short | Gastric volvulus with perforation 1 year after total pancreatectomy: a case report |
| title_sort | gastric volvulus with perforation 1 year after total pancreatectomy a case report |
| topic | Pancreatic intraductal neoplasms Pancreatectomy Stomach volvulus |
| url | http://link.springer.com/article/10.1186/s40792-020-00840-x |
| work_keys_str_mv | AT yusuketakahashi gastricvolvuluswithperforation1yearaftertotalpancreatectomyacasereport AT hitoshiseki gastricvolvuluswithperforation1yearaftertotalpancreatectomyacasereport |