C Palanivelu, MS, MCh, FACS, P Senthilnathan, MS, R Parthasarathi, MS, P Praveen Raj, MS, P S Rajan, MS, S Bansal, MS, V P Nalankilli, MS. GEM Hospital & Research Centre, Coimbatore, INDIA.
Background
Annular pancreas is a congenital disorder which may occur in 5-15% people per 1,00,000 people.It may be incomplete in 75% and complete in 25 % of the cases.Patients generally present with repeated vomitings, pain abdomen and sometimes deranged liver function tests. Here we present a video of a patient presenting with gastric outlet obstruction symptoms, whom we managed with Laparoscopic Duodeno-jejunostomy
Technique
Patient Position-was placed supine with 20-degree head-up. Legs split apart.
Surgeon Position-Surgeon in between legs, Camera Surgeon on right and 1st assistant on left
Port Position- 5 mm ports-epigastric region, Rt Lumbar region
10 mm port below umbilicus and Lt Lumbar region
Gastrocolic omentum is divided and lesser sac entered. Hepatic flexure and Transverse colon is brought down to expose head of pancreas and second and third part of duodenum.
Roux loop of jejunum 40 cms from DJ flexure brought upto the duodenum. Most caudal part of the D II is selected. Stay sutures taken. Using Endo GI Stapler (45mm,White load) side to side Duodenojejunostomy performed. Common opening closed with PDS 2-0 sutures.
Post-op course-Patient had an uneventful recovery. On 3rd postoperative day he passed flatus. Review scan was done to rule out any collection and was found to be normal. Feeding was gradually started from 4 th postoperative day and ischarged on 6th post-op day.
Conclusion
Annular pancreas causing duodenal obstruction is a rare event. But it can be safely tackled by performing Duodeno-jejunostomy laparoscopically.
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