PMC7545421_01
Preoperative CT scan. White arrow: biliary tree dilatation, Black arrow: right hydronephrosis. CT: celiac trunk; D: duodenum; GB: gallbladder; HA: hepatic artery; L: liver; P: pancreas; S: spleen; SA: splenic artery; W: Wirsung duct.
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fig1
A study with computed tomography (CT) scan of the abdomen showed biliary system dilatation associated with a huge cystic pancreatic mass adjacent to the right kidney and right hydronephrosis (Figure 1).
Operative field after the section of gastrocolic ligament.
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fig2
The voluminous tumor pushed anteriorly the gastric posterior wall and determined surgical planes alteration with caudal dislocation of transverse mesocolon (Figure 2).
Schematic representation of the two-step procedure. GDA: gastroduodenal artery; CBD: common bile duct; GB: gallbladder; IMV: inferior mesenteric vein; PHA: proper hepatic artery; PV: portal vein; SV: splenic vein; SA: splenic artery; SMV: superior mesenteric vein; SMA: superior mesenteric artery.
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fig3
Initially, hepatic flexure, distal transverse colon, and splenic flexure were mobilized; the procedure was performed in two steps considering the impact of tumor size on high-risk surgical maneuvers (Figure 3).
The specimen.
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fig4
Aspects of chronic pancreatitis and foci of endocrine tissue were described in a small portion of the specimen (Figure 4).