A Resected Case of Carcinoma of Pancreas with Intraductal Spread Diagnosed by Intraoperative Pancreatography

Yoshihisa Shibata, Yuji Nimura, Junichi Kamiya, Shoji Maeda, Katsushi Okamoto, Shigehiko Shionoya

First Department of Surgery, Nagoya University School of Medicine

We have decided on the line for the resecting pancreas because of intraductal spread of pancreatic cancer. For a pancreatic cancer with an irregular dilated main pancreatic duct (MPD) in its body or tail, we selecte the operative fashion by intraoperative pancreatography. A 50-year-old man visited Nagoya University Hospital because of malaise and jaundice. Ultrasonography and percutaneous transhepatic cholangiography revealed a pancreatic head mass and a dilated common bile duct. Endoscopic retrograde pancreatography showed an obstruction of the MPD at the pancreatic head. Abdominal computed tomography revealed the pancreatic head mass and irregular dilated MPD in the body and tail of the pancreas. Intraoperative pancreatography showed irregular dilatation of the MPD in the distal pancreas and a papillary tumor was seen inside. We diagnosed the condition as pancreatic head carcinoma with intraductal spread, and performed a total pancreatecotmy. Pathological findings indicated cancer extension in the MPD from head to tail into its branches with papillary multiplication. Intraoperative pancreatography is an effective method to detect the ductal spread of carcinoma of the pancreatic head and is use for decide the cutting margin of the pancreas remnant.

Key words
pancreatic cancer, total pancreatectomy, intraoperative pancreatography

Reprint requests
Yoshihisa Shibata First Department of Surgery, Nagoya University School of Medicine
65 Tsurumai-cho, Shouwa-ku, Nagoya, 466 JAPAN

Accepted
March 13, 1991

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