A Case of Serous Cystadenoma of the Pancreas, which Required Concomitant Segmental Excision of the Portal Vein and the Right Hepatic Artery

Nobuyasu Yamasaki, Fumitaka Oike, Kazuhiko Manabe, Masaki Hasegawa, Kentarou Takagi, Takanobu Koyama

Department of Surgery, Niigata Prefectural Central Hospital

A case of serous cystadenoma of the pancreas with obstructive jaundice, which required concomitant segmental excision of the portal vein and the right hepatic artery (r.HA) is reported. The patient was a 59-year-old woman who visited our hospital with generalized itching and jaundice, and she had a hard tumor with slight tenderness in the epigastrium. Abdominal ultrasonography and computed tomography showed a multilocular tumor 6 cm in diameter in the head of the pancreas. A cytological diagnosis of class V was obtained from transhepatic biliary decompression through the gallbladder, and pancreatoduodenectomy was performed. Because of intense adhesion of the tumor to the portal vein and the involvement of the r.HA which originated from the superior mesenteric artery in the tumor, concomitant segmental excision and reconstruction of both vessels were performed. Reconstruction of the r.HA failed, and patency of the left HA was also lost postoperatively, because of manipulation along the course of dissection necessitated by the intense compression by the tumor mass. Fortunately, deterioration of hepatic function was transient. The postoperative course was uneventful thereafter. Histological examination led to a diagnosis of serous cystadenoma of the pancreas. Re-evaluation of the preoperative biliary cytology changed the diagnosis to class II. This case is interesting in the sense that this tumor showed expansive growth not only to the portal vein but also to the common bile duct and the main pancreatic duct, which was suspected of apparent invasion in spite of its benign nature.

Key words
serous cystadenoma of the pancreas, obstructive jaundice due to cystadenoma of the pancreas, pancreatoduodenectomy with vascular reconstruction

Reprint requests
Nobuyasu Yamasaki Department of Surgery, Uwajima City Hospital
1-1 Gotenmachi, Uwajima, 798 JAPAN

Accepted
June 17, 1992

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