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Circumportal pancreas: A report of two cases
Ann Hepatobiliary Pancreat Surg 2019 Aug;23(3):300-4
Published online August 31, 2019;  https://doi.org/10.14701/ahbps.2019.23.3.300
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Tousif Kabir1,2, Zoe Tan Zhuo Xuan2, and Alexander Yaw Fui Chung2

1Department of General Surgery, Hepatopancreatobiliary Service, Sengkang General Hospital, 2Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
Received November 14, 2018; Revised November 18, 2018; Accepted December 26, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Circumportal pancreas (CP) is an unusual pancreatic anomaly occurring in 1.1 to 2.5% of individuals, where there is abnormal fusion of the uncinate process to the main pancreatic body occurring to the left of the portal vein-superior mesenteric vein (PV-SMV) junction. Since it was first described in 1987, there have only been a few reports documented in the literature. We recently encountered 2 such cases. Patient 1 was an 81-year-old man who presented with weight loss. Computed tomography (CT) scan revealed an atrophic pancreas with dilated pancreatic duct and a nodule at the head of pancreas, suspicious for a main-duct intraductal papillary mucinous neoplasm (IPMN) with malignant change. During surgery, we discovered that the uncinate process of the pancreas was completely wrapped around the SMV and fused with the main body, resulting in encasement of the PV-SMV junction. The patient also had a replaced right hepatic artery (RHA). Patient 2 was a 76-year-old man who complained of several weeks of abdominal discomfort. A CT scan showed a dilated common bile duct with a distal mass, worrisome for distal cholangiocarcinoma. Intra-operatively, he was similarly found to have union of the uncinate process of the pancreas with the main body occurring to the left of the PV-SMV confluence, with bilateral anomalous hepatic arteries. We present a brief review of the literature surrounding this condition. Although CP is usually asymptomatic, failure to recognize it may lead to serious consequences.
Keywords : Circumportal; Annular; Pancreas; Portal

 

August 2019, 23 (3)