Whipple with vascular resection and reconstruction [Case 23]


A 62 year old woman initially presented with jaundice 6-months ago. She was found to have an ill-defined pancreatic adenocarcinoma in the head of the pancreas measuring 3.7 x 2.5cm. The mass appears to involve over 180° of the PV-SMV for a length of 2.5cm, with the SMV almost completely occluded. There is also involvement of the SMA (less than 180°). The lesion was deemed borderline resectable with possibility of vascular reconstruction. 

She received a metal stent in the common bile duct to relieve the jaundice and then underwent chemoradiation. The pancreatic lesion has decreased slightly in size, to 2.4cm. There are some collaterals likely due to occlusion of the SMV. The patient has developed moderate to severe steatosis, but her biliary dilatation and pancreas is stable. The common hepatic and celiac artery do not appear to be involved. There is dilatation of the pancreatic duct upstream of the lesion. Some peri-pancreatic nodes up to 0.5cm are seen. Her liver parenchymal changes are likely a result of inflammation from dilatation and biliary stenting.

Our plan is to prepare for a Whipple operation (pancreaticoduodenectomy) with vascular reconsctruction.

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