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This case study discusses a 12-year-old girl with a solid pseudopapillary tumor in the pancreas, undergoing parenchyma preserving pancreatic resections by Dr. V. Gandhi.
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Parenchyma Preserving Pancreatic Resections Dr. V Gandhi
12 yr old girl • H/o • Pain abdomen left hypochondrium-1yr • Increased since 3-4 months • Episodic, last one week back. • Vomiting associated with pain, bilious • Wt loss from one month • No other GI Symtoms
Examination • GPE-WNL • P/A • Non distended, soft • Tenderness in epigastric region • No palpable lump • BS+ • Chest/CVS/CNS-NAD
Investigations HB-11.6 PCV-37.5 TLC-11800 (N-58,L-38,M-2,E-2,B-0) Plt-4.0 RBS-112 Urea-24 Cr-0.6 CA-19-9 -12(upto37u/ml) Amylase-93 ESR-16 PT- 12.8/13.0 APTT- 32.9/30.0 Tot pro - 6.9 Ser albumin-4.8 Bilirubin T - 0.6 ALP-455 (n-upto 850) SGOT-10 SGPT-10 HIV,HBsAg -ve
Radiology • USG Abd : • Well defined hypoechoic mass lesion in the region of head of pancreas with increased vascularity in it.
Head mass pancreas Impression
Hepatic artery Tumor Normal pancreas Gastro-Du artery
Tumor Distal pancreas Normal pancreas SMV
Reconstruction Proximal stump closed Duct to mucosa PJ to distal stump
4 X 4 cm solid tumor in the neck of the pancreas overlying the SMV Rest of pancreas normal Few nodes along the hepatic artery Liver N, Vessels free Intra – op findings
Median Pancreatectomy with duct to mucosa PJ Operativeprocedure
Solid pseudo – papillary tumor • Lymph nodes – reactive hyperplasia HPR
It was first described by Frantz. • Solid-pseudopapillary tumor of the pancreas is a rare benign or low-grade malignant lesion. • Occurs most commonly in young women and girls.
Local infiltration, distant metastasis and recurrence are very rare. • The histogenetic origin of the tumor cell remains to be elucidated. Solid-pseudopapillary tumor of the pancreas in a 9-year-old girl. Meyer S etal
Although the tumor reaches a large diameter, complete tumor resection has a very good prognosis (Solid-pseudopapillary tumors in childhood.Lange S etal)
Benign or low grade malignant lesions No suspicion of malignancy Preserves exocrine and endocrine function Spleen preservation Preserves the gastro duodenal continuity Complication – pancreatic fistula 0-30%
50 yrs male Fall from height No other symptoms Lab – normal Case capsule
Tachycardia BP – 100/60 mm hg P/A – distended Resuscitation in ICU Case capsule
Grade 3 pancreatic trauma Spleen preserving distal pancreatectomy
Grade I detected at surgery for associated injuries Grading & Management I • Grade II • Pre op detected – Conservative Laparotomy & drainage II
Grade III • Distal Pancreatectomy + Splenectomy • Spleen preserving distal pancreatectomy Grading & Management III
Grade IV • Debridement + distal ductal drainage Grading & Management IV Roux en Y Pancreaticojejunostomy ( after 3 months) • Grade V ---- Whipples