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Prof. Dr. Hossam Abd El Kader El Fol

Pancreas

Pancreas :

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Case 1: Presented by jaundice, total bilrubin 7 mg/dl

HEAD OF PANCREAS :
Male patient, 48 years old, presented by jaundice, total bilrubin 7 mg/dl, CT scan abdomen mass 2 x 2.5 cm in the head of pancreas.
ERCP and stent to CBD to relive jaundice.
Thin sections of CT scan to evaluate to extent of disease and assets tumor respectability to asses LN and vascular condition (laporatomy should be therapeutic not diagnostic (2).
Surgical resection of carcinoma of pancreatic head remains the only curative treatment i.e pancreatico dudenectomy.

Mobilization of the right colon to expose the third and fourth portion of dudenum, mobilization of retroperitonial attachment of the messentry of small intestine.

Kocher maneuver is continued to left lateral edge of aorta.

Routine division of the middle colic vein or gastrocolic trunk allow exposer of superior mesenteric vein and prevents iatrogenic traction injuries during dissection of the middle colic vein - SMV junction (2).

ortal dissection exposing the common hepatic artery and distal gastrodudenal artery and ligation of gastrodudenal artery, transaction of the common bile duct with removal of LNs on the hepatic artery and portal vein.

Transaction of the jejunum 10 cm distal to ligament of Treitz.
Resection of pancreatic head by electrocautary at the level of portal vein.

Specimen tumor, head of pancreas, lower common bile duct, duodenum, distal stomach.


Tail of pancreas :
Female patient , 55 years old , presented by upper abdominal pain

CT scan abdomen reveled cystic lesion on the tail of pancreas

After exploration to the abdominal to exclude extra pancreatic disease

Complete mobilization of the spleen and ligation of short gastric vessels, mobilization of tail and body of pancreas and localization of safety margins behind the lesion.

Ligation of spleenic artery to minimize blood loss.

Removal of spleen, tail, cyst and safety margins.

Open the cyst showing papillary growth, pathology
cystadenocarcinoma.


Case 3: Under construction
Under construction