case_images: PMC6371588_01
case_images: MRI (axial T1 weighted) of the 2017 pancreatic mass. The image was read to show interval development of a mass within the pancreatic body-tail junction with restricted diffusion and hypoenhancement. The mass was measured to be 2.3 x 2.2 cm (see arrow), and it was felt to focally encase the splenic artery and segmentally narrow the splenic vein.
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case_images: f1
case_images: In 2017, a biannual screening MRI with intravenous contrast showed a new pancreatic lesion measuring 2.3 x 2.2 cm in the tail of the pancreas (Fig. 1).
case_images: Chronologic results of CA 19-9. Results are listed starting before the initial tumor resection in 2011 to identification of the new tumor in the pancreatic remnant in 2017.
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case_images: f2
case_images: When the patient presented to our institution a few months later, the CA 19-9 had returned to normal at 32 U/mL (Fig. 2), and there was a moderate increase in CEA (16.9 ng/mL; normal <3 ng/mL).
case_images: Operative procedure summary; left depicting the patient's postclassic Whipple procedure anatomy (2011 surgery) and right depicting the patient's postrevision completion pancreatectomy anatomy (2017 surgery). Gastrojejunostomy was revised to address the patient's early satiety and cholangitis, which was thought to be due to a short afferent limb.
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case_images: f3
case_images: The anatomy before and after this operation is shown in Figure 3.