case_images: PMC7545421_01
case_images: 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.
case_images: CRIS2020-8879609.001.jpg
case_images: PMC7545421_01_CRIS2020-8879609.001.jpg
case_images: fig1
case_images: 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).
case_images: Operative field after the section of gastrocolic ligament.
case_images: CRIS2020-8879609.002.jpg
case_images: PMC7545421_01_CRIS2020-8879609.002.jpg
case_images: fig2
case_images: The voluminous tumor pushed anteriorly the gastric posterior wall and determined surgical planes alteration with caudal dislocation of transverse mesocolon (Figure 2).
case_images: 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.
case_images: CRIS2020-8879609.003.jpg
case_images: PMC7545421_01_CRIS2020-8879609.003.jpg
case_images: fig3
case_images: 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).
case_images: The specimen.
case_images: CRIS2020-8879609.004.jpg
case_images: PMC7545421_01_CRIS2020-8879609.004.jpg
case_images: fig4
case_images: Aspects of chronic pancreatitis and foci of endocrine tissue were described in a small portion of the specimen (Figure 4).