Pancreaticoduodenectomy without pancreaticojejunostomy in a patient with near-complete fatty replacement of the distal pancreas: a surgical technique
Year: 2026
Type: article
Study design: Case Report
Abstract: Pancreaticojejunostomy after pancreaticoduodenectomy presupposes a viable distal pancreatic remnant with a drainable ductal system. We report a 68-year-old woman in whom this prerequisite was absent because the pancreatic body and tail were almost completely replaced by fat. The pancreatic-head cystic lesion was discovered incidentally during evaluation of an L3 compression fracture. She had no abdominal symptoms or jaundice. Computed tomography (CT) and magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) showed a 5.9-6.1 cm well-circumscribed, septated honeycomb lesion in the pancreatic head, favoring a microcystic serous cystic neoplasm (SCN), without biliary or main pancreatic duct dilatation; the body and tail were not recognizable as continuous pancreatic parenchyma and appeared to be replaced by fat. Because a mucinous cystic neoplasm could not be excluded with sufficient confidence, the patient chose resection after counselling. At open pancreaticoduodenectomy, the expected distal pancreatic region consisted of adipose tissue without recognizable gland. After pancreatic-neck transection, direct inspection identified neither a pancreatic duct nor visible pancreatic juice, and no suitable parenchyma was available for anastomosis. Pancreaticojejunostomy was therefore not performed, and the transection surface was closed directly. Permanent pathology confirmed microcystic serous cystadenoma with negative margins. No clinically apparent pancreatic fistula or intra-abdominal collection requiring intervention was documented; postoperative calf deep-vein thromboses and supraventricular tachycardia were treated. At approximately 6 months, CT showed no recurrent mass. Systematic glycated hemoglobin (HbA1c), insulin requirement, steatorrhea, pancreatic enzyme replacement, and other formal endocrine/exocrine outcomes were not available, precluding conclusions about long-term functional safety. The report illustrates an individualized reconstructive decision applicable only when viable distal pancreatic parenchyma and a meaningful ductal target are genuinely absent.
Source: Gland Surgery
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7222617331