Successful resection of pancreatic head cancer in a patient with circumportal pancreas: a case report with technical consideration

We report a case of pancreaticoduodenectomy for pancreatic head cancer with circumportal pancreas (CP). A 76-year-old woman was referred to our hospital with complaint of generalized pruritus. Dynamic computed tomography (CT) revealed an unenhanced mass at the head of the pancreas and a dilated main pancreatic duct (MPD) behind the superior mesenteric vein (SMV). She was diagnosed with pancreatic head cancer with CP and underwent subtotal stomach-preserving pancreaticoduodenectomy (SSpPD). The pancreas was transected both beneath and above the SMV, and the dominant dorsal edge of the pancreas was mobilized and anastomosed with the gut, whereas the ventral edge was closed by suture and attached to the gut. The postoperative course was uneventful without the occurrence of pancreatic fistula or bleeding. CP is a rare anomaly in which a portal vein (PV) is encircled by the annular pancreatic parenchyma. CP is usually asymptomatic without any significant comorbidity but may become a surgical hazard when pancreaticoduodenectomy is performed. We report our successfully treated case, with special references to the technical approach for pancreatic anastomosis.