Pancreas-Preserving Approach to “Paraduodenal Pancreatitis” Treatment: Why, When, and How? Experience of Treatment of 62 Patients with Duodenal Dystrophy
Figure 2
Duodenal dystrophy with moderate chronic orthotopic pancreatitis. Patient, 32 y.o. Scheme of the pancreas-preserving resection of the second portion of the duodenum. (a) The second part of the duodenum, including the main papilla, is removed and the segment of the proximal jejunum supplied by the artery and vein is cut out and prepared for transposition between the 1st and 3rd portions of the duodenum; (b) the shifted segment is interposed between the 1st and the 3rd parts of the duodenum. Jejuno-jejuno- and duodeno-jejuno-anastomoses are performed. The bile and the pancreatic ducts were implanted in the neoduodenum 4 cm below the proximal duodeno-jejuno-anastomosis; (c) the resected specimen of the second part of the duodenum. A large scarry-sided cyst in the medial duodenal wall is shown (arrow). Forceps were introduced into the duodenum to show the absence of communication between the cystic and duodenal lumen.
