Pancreatic Head Cancer with Adult Reversed Rotation Treated by Pancreaticoduodenectomy

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 49; no. 4; pp. 317 - 325
• Main Authors: Tsutsumi, Shinji, Toyoki, Yoshikazu, Kagiya, Takuji, Kimura, Toshiro, Kimura, Norihisa, Kudo, Daisuke, Ishido, Keinosuke, Hakamada, Kenichi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.04.2016
• Subjects: intestinal malrotation; pancreaticoduodenectomy; reversed rotation
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2015.0045

A 54-year-old man was admitted to a hospital because of jaundice and high fever due to a tumor of the pancreatic head. He was then transferred to our institution after percutaneous transhepatic biliary drainage. Abdominal CT revealed wall thickening and stenosis of the distal bile duct. The superior mesenteric artery (SMA) was located on the right side of the superior mesenteric vein (SMV). Pancreaticoduodenectomy (PD) was performed under the diagnosis of distal bile duct cancer and intestinal malrotation. During the operation, the third portion of the duodenum was located on the ventral side of the SMA, with the absence of the ligament of Treitz. The transverse colon was located on the dorsal side of the SMA, and the cecum on the right side of the artery. These findings revealed a reversed intestinal malrotation. The final pathological diagnosis was pancreatic ductal carcinoma with invasion to the bile duct and portal vein, and no distal bile duct cancer. We report herein an extremely rare case of pancreatic cancer with adult reversed rotation treated by PD.