PMC6700401_01
CT cut through the mid-abdomen in a 39 year old woman with recurrent right colon cancer. The staple line from the prior ileocolic anastomosis is in the central portion of the mass. A stent is in the obstructed right ureter.
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No bowel obstruction was present (Fig. 1).
Total duodenectomy with detachment of the ampulla of Vater. Proximal transection at point A is distal stomach just proximal to the pylorus. Distal transection at point B is at the junction of fourth portion of the duodenum and jejunum.
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The limits of the duodenal resection are shown in Fig. 2.
Ampulla of Vater is jejunal anastomosis. After the enterotomy in the jejunum is made, a line of sutures inferiorly is made with absorbable sutures tied on the inside of jejunum. Superiorly, the sutures are placed to be tied outside the jejunum.
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The knots from this line of sutures was on the inside of the jejunum (Fig. 3).
An anastomosis of end of stomach to antimesenteric border of jejunum completes the reconstruction.
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To complete the reconstruction the antimesenteric aspect of the jejunum was sutured to the stomach just proximal to the pylorus (Fig. 4).