JOP. J Pancreas (Online) 2010 Sep 6; 11(5):446-452.

Pancreas-Preserving Duodenal Resections with Bile and Pancreatic Duct Replantation for Duodenal Dystrophy. Two Case Reports

Viacheslav Ivanovich Egorov1, Alexander Cezarevich Butkevich2, Alexander Viacheslavovich Sazhin3, Nina Ivanovna Yashina1, Sergei Nikolaievich Bogdanov2

1The Vishnevsky Institute of Surgery; 2Main Hospital of the Russian Federal Security Service; 3Russian State Medical University, Pediatric Faculty, Chair of General Surgery. Moscow, Russia


Context Duodenal dystrophy is a rare disease, characterized by the chronic inflammation of the aberrant pancreatic tissue in the duodenal wall.

Case reports Two middle-aged men were admitted with upper abdominal pain of several months duration, periodic nausea and vomiting after meals, intermittent jaundice and weight loss. A diagnosis of cystic dystrophy of the vertical part of the duodenum without chronic inflammation of the orthotopic pancreas was established in both cases by multi-detector computed tomography, magnetic resonance imaging and endosonography. Both patients were successfully treated by two modifications of pancreas-preserving duodenal resections with reimplantation of the bile and pancreatic ducts into the neoduodenum.

Conclusion These cases are a good example of a pancreas-preserving approach to duodenal dystrophy treatment and can be an alternative to the Whipple procedure in cases of mild changes of the orthotopic gland.

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  1. Potet F, Duclert N. Dystrophie kystique sur pancreas aberrant de la paroi duodenale. (Cystic dystrophy on aberrant pancreas of the duodenal wall). Arch Fr Mal App Dig 1970; 59:223. [More details]

  2. Pang LC. Pancreatic heterotopia: a reappraisal and clinicopathologic analysis of 32 cases. South Med J 1988; 81:1264-75. [More details]

  3. Ponchon T, Napoleon B, Hedelius F, Bory R. Traitement endoscopique de la dystrophie kystique de la paroi duodénale. Gastroenterol Clin Biol 1997; 21:A63. [More details]

  4. Rubay R, Bonnet D, Gohy P, Laka A, Deltour D. Cystic dystrophy in heterotopic pancreas of the duodenal wall: medical and surgical treatment. Acta Chir Belg 1999; 99:87-91. [More details]

  5. Bittar I, Cohen Solal JL, Cabanis P, Hagege H. Cystic dystrophy of an aberrant pancreas. Surgery after failure of medical therapy. Presse Med 2000; 29:1118-20. [More details]

  6. Basili E, Allemand I, Ville E, Laugier R. Lanreotide acetate may cure cystic dystrophy in heterotopic pancreas of the duodenal wall. Gastroenterol Clin Biol 2001; 25:1108-11. [More details]

  7. Glaser M, Roskar Z, Skalincky M, Krajnc I. Cystic dystrophy of the duodenal wall in a heterotopic pancreas. Wien Klin Wochenschr 2002; 114:1013-6. [More details]

  8. Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying 'cystic dystrophy of heterotopic pancreas', 'para-duodenal wall cyst', and 'groove pancreatitis'. Semin Diagn Pathol 2004; 21:247-5. [More details]

  9. Egorov VI, Kubyshkin VA, Karmazanovskii GG, Shchegolev AI, Kozlov IA, Iashina NI, et al. Heterotopy of pancreatic tissue as a cause of chronic pancreatitis. Typical and rare cases. Khirurgiia (Mosk) 2006; 11:58-62. [More details]

  10. Fléjou JF, Potet F, Molas G, Bernades P, Amouyal P, Fékété F. Cystic dystrophy of the gastric and duodenal wall developing in heterotopic pancreas: an unrecognized entity. Gut 1993; 34:343-7. [More details]

  11. Kloppel G. Chronic pancreatitis, pseudotumors and other tumor-like lesions. Mod Pathol 2007, 20(Suppl 1):113-31. [More details]

  12. Rebours V, Lévy P, Vullierme MP, Couvelard A, O'Toole D, Aubert A, et al. Clinical and morphological features of duodenal cystic dystrophy in heterotopic pancreas. Am J Gastroenterol 2007; 102:871-9. [More details]

  13. Jovanovic I, Alempijevic T, Lukic S, Knezevic S, Popovic D, Dugalic V, et al. Cystic dystrophy in heterotopic pancreas of the duodenal wall. Dig Surg 2008; 25:262-8. [More details]

  14. Ravitch MM. Anomalies of the pancreas. In: Cary LC, ed. The Pancreas. St.Louis: C.V. Mosby, 1973. [More details]

  15. Skandalakis JE, Skandalakis LJ, Colborn GL. Congenital anomalies and variations of the pancreas and pancreatic and extrahepatic bile ducts. In: Beger HG, Warshaw AL, Büchler MW, Carr-Locke DL, Neoptolemos JP, Russell C, et al., eds. The Pancreas, Oxford, Blackwell Science, 1998:28-30. [More details]

  16. Jeng KS, Yang KC, Kuo SH. Malignant degeneration of heterotopic pancreas. Gastrointest Endosc 1991; 37:196-8. [More details]

  17. Tanimura A., Yamamoto H., Shibata H., Sano E. Carcinoma in hetrotopic gastric pancreas. Acta Pathol Japan 1979, 29:251-7. [More details]

  18. Marmorale A, Tercier S, Peroux JL, Monticelli I, Mc Namara M, Huguet C. Dystrophie kystique du deuxième duodénum sur pancréas aberrant. Un cas de traitement chirurgical conservateur. (Cystic dystrophy in heterotopic pancreas of the second part of the duodenum. One case of conservative surgical procedure). Ann Chir 2003; 128:180-4. [More details]

  19. Chung RS, Church JM, vanStolk R. Pancreas-sparing duodenectomy: indications,surgical technique and results. Surgery 1995; 117:254-9. [More details]

  20. Maher MM, Yeo CJ, Lillemoe KD, Roberts JR, Cameron JL. Pancreas-sparing duodenectomy for infra-ampullary duodenal pathology. Am J Surg 1996; 171:62-7. [More details]

  21. Tsiotos GG, Sarr MG. Pancreas-preserving total duodenectomy. Dig Surg 1998; 15:398-403. [More details]

  22. Nagai H, Hyodo M, Kurihara K, Ohki J, Yasuda T, Kasahara K, et al. Pancreas-sparing duodenectomy: classification, indication and procedures. Hepatogastroenterology 1999; 46:1953-8. [More details]

  23. Sarmiento JM, Thompson GB, Nagorney DM, Donohue JH, Farnell MB. Pancreas-sparing duodenectomy for duodenal polyposis. Arch Surg 2002; 137:557-62. [More details]

  24. Kalady MF, Clary BM, Tyler DS, Pappas TN. Pancreas-preserving duodenectomy in the management of duodenal familial adenomatous polyposis. J Gastrointest Surg 2002; 6:82-7. [More details]

  25. Lundell L, Hyltander A, Liedman B. Pancreas-sparing duodenectomy: technique and indications. Eur J Surg 2002; 168:74-7. [More details]

  26. Eisenberger CF, Knoefel WT, Peiper M, Yekebas EF, Hosch SB, Busch C, Izbicki JR. Pancreas-sparing duodenectomy in duodenal pathology: indications and results. Hepatogastroenterology 2004; 51:727-31. [More details]

  27. Yadav TD, Kaushik R. Pancreas-sparing duodenectomy for trauma. Trop Gastroenterol 2004; 25:34-5. [More details]

  28. Köninger J, Friess H, Wagner M, Kadmon M, Büchler MW. Technique of pancreas-preserving duodenectomy. Chirurg 2005; 76:273-81. [More details]

  29. Mackey R, Walsh RM, Chung R, Brown N, Smith A, Church J, Burke CJ. Pancreas-sparing duodenectomy is effective management for familial adenomatous polyposis. J Gastrointest Surg 2005; 9:1088-93. [More details]

  30. Imamura M, Komoto I, Doi R, Onodera H, Kobayashi H, Kawai Y. New pancreas-preserving total duodenectomy technique. World J Surg 2005; 29:203-7. [More details]

  31. Egorov VI, Karmazanovsky GG, Schegolev AI, Yashina NI, Stepanova JA, Solodinina EN, et al. Importance of preoperative imaging of duodenal gastrointestinal stromal tumors for the choice of a surgical procedure. Eur J Radiol Extra 2007; 63:29-34. [More details]

  32. Konishi M, Kinoshita T, Nakagohri T, Takahashi S, Gotohda N, Ryu M. Pancreas-sparing duodenectomy for duodenal neoplasms including malignancies. Hepatogastroenterology 2007; 54:753-7. [More details]

  33. Tison C, Regenet N, Meurette G, Mirallié E, Cassagnau E, Frampas E, Le Borgne J. Cystic dystrophy of the duodenal wall developing in heterotopic pancreas: report of 9 cases. Pancreas 2007; 34:152-6. [More details]

  34. Al-Sarireh B, Ghaneh P, Gardner-Thorpe J, Raraty M, Hartley M, Sutton R, Neoptolemos JP. Complications and follow-up after pancreas-preserving total duodenectomy for duodenal polyps. Br J Surg 2008; 95:1506-11. [More details]

  35. de Castro SM, van Eijck CH, Rutten JP, Dejong CH, van Goor H, Busch OR, Gouma DJ. Pancreas-preserving total duodenectomy versus standard pancreatoduodenectomy for patients with familial adenomatous polyposis and polyps in the duodenum. Br J Surg 2008; 95:1380-6. [More details]

  36. Imamura M., Komoto I. Surgical treatment of the gastrinoma. In: Beger HG, Matsuno S, Cameron JL, eds. Diseases of the Pancreas. Current Surgical Therapy. Berlin-Heidelberg: Springer, 2008, 723-34. [More details]

  37. Müller MW, Dahmen R, Köninger J, Michalski CW, Hinz U, Hartel M, et al. Is there an advantage in performing a pancreas-preserving total duodenectomy in duodenal adenomatosis? Am J Surg 2008; 195:741-8. [More details]

  38. Ryu M, Kinoshita T, Konishi M, Kawano N, Arai Y, Tanizaki H, Cho MH. Segmental resection of the duodenum including the papilla of Vater for focal cancer in adenoma. Hepatogastroenterology 1996; 43:835-8. [More details]

  39. Imaizumi T, Ishii M, Tobita K, Douwaki S, Makuuchi H. Cancer of the duodenum: surgical treatment. In: Beger HG, Matsuno S, Cameron JL, eds. Diseases of the Pancreas. Current Surgical Therapy. Berlin-Heidelberg: Springer, 2008: 817-26. [More details]

Keywords Duodenal Diseases; Duodenal Obstruction; Pancreaticoduodenectomy; Pancreatitis

Correspondence Viacheslav I Egorov:

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