case_images: PMC11021039_01
case_images: CT images and intraoperative findings in case 1. a Axial view. CT imaging showed enhancement of the tumor in a distal BD (arrows). b Intraoperative finding of PAP after resection of the anteportal pancreas just above the PV. The retroportal pancreas could not be separated from the uncinate process. c Sagittal view. An existence of the PAP found from the CT image. BD, bile duct; CT, computed tomography; GB, gallbladder; MPD, main pancreatic duct; PAP, portal annular pancreas; PV, portal vein; SMV, superior mesenteric vein.
case_images: crg-2024-0018-0001-538370_F01.jpg
case_images: PMC11021039_01_crg-2024-0018-0001-538370_F01.jpg
case_images: F1
case_images: Enhanced CT examination revealed a protruding tumor in a distal bile duct (Fig. 1a), and adenocarcinoma was detected from cytopathology using endoscopic retrograde cholangiopancreatography. During surgery, the anteportal pancreas was transected just above the PV; however, the pancreas could not be separated from the uncinate process and the PV (Fig. 1b). We confirmed PAP from CT images (Fig. 1c).
case_images: PMC11021039_02
case_images: CT images and intraoperative findings in case 2. a Axial view. CT imaging showed common bile duct dilation and indicated a tumor in a distal BD (arrow). b Sagittal view. PAP was recognized from the CT image before surgery (arrowhead). c MRCP imaging of the T2 fat-suppressed image (left) and maximum intensity projection image (right). The MPD ran through the anteportal pancreas, and no pancreatic duct passed through the retroportal pancreas. d Left panel shows intraoperative finding of PAP after resection of the anteportal pancreas just above the PV. The right panel shows the stump of the retroportal pancreas after resection by stapling system. BD, bile duct; CT, computed tomography; MPD, main pancreatic duct; MRCP, magnetic resonance cholangiopancreatography; PAP, portal annular pancreas; PV, portal vein.
case_images: crg-2024-0018-0001-538370_F02.jpg
case_images: PMC11021039_02_crg-2024-0018-0001-538370_F02.jpg
case_images: F2
case_images: A low-density mass was found in a distal bile duct by CT examination (Fig. 2a), and adenocarcinoma was diagnosed by scraping cytology of the endoscopic retrograde cholangiopancreatography. PAP was recognized from CT (Fig. 2b), and magnetic resonance cholangiopancreatography (MRCP) (Fig. 2c) performed before bile drainage. The dorsal pancreas was sufficiently dissected from the dorsal side of the PV and transected using the stapler (Fig. 2d).