PMC5554987_01
Contrast-enhanced computed tomography images: a. A tumor of approximately 4.0 cm in the pancreatic head with invasion extending into the plexus nerve around the superior mesenteric artery (SMA) before chemotherapy (arrow); b. The tumor occluded the superior mesenteric vein (SMV) completely. The tumor was diagnosed as an unresectable locally advanced pancreatic head cancer; c. After chemotherapy, the tumor shrunk substantially, and the invasion into the plexus nerve around the SMA became unclear (arrow); d. The SMV became patent. The tumor was diagnosed as a borderline resectable pancreatic cancer.
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Abdominal contrast-enhanced computed tomography (CT) showed a tumor of approximately 4.0 cm in the pancreatic head with invasion extending into the plexus nerve around the superior mesenteric artery (SMA) (Fig. 1a). The tumor occluded the superior mesenteric vein (SMV) completely (Fig. 1b), but no distant metastasis was found. The tumor shrunk extremely, and the invasion into the plexus nerve around the SMA became unclear (Fig. 1c). In addition, the SMV became patent (Fig. 1d).
Overview of an intestinal rotation method for digestive reconstruction after pancreaticoduodenectomy combined with an en bloc extended right hemicolectomy.
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The overview of this technique is shown in Fig. 2.
After transection of the proximal jejunum and the distal ileum, the entire intestinal mesentery was rotated 180  forward counterclockwise around the axis of superior mesenteric artery.
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At first, the entire intestinal mesentery was rotated 180  forward counterclockwise around the axis of the SMA (Fig. 3).
Overview of conventional reconstruction after combined pancreaticoduodenectomy and right hemicolectomy.
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In conventional reconstruction after combined PD and RH, only the upper proximal jejunum mesentery is rotated around the axis of the SMA and brought up to perform pancreatojejunostomy and hepatojejunostomy reconstruction (Fig. 4).