Fulltext (PDF)
DOI: 10.48087/BJMS.2026.130324
Authors: Youcef KHENCHOUL1, Hichem El Azhari BENMAMAR2, Mustapha BOUMENDJEL3, Dalel ZERROUK4, Imen HAMIOUDA5
Affiliations: 1- Service de Chirurgie (A) Ibn Sina, CHU Benbadis, Constantine – Algérie. 2- service d’imagerie médical CHUC – Algérie. 3- service de gastro entérologie CHUC – Algérie. 4- service d’oncologie médicale CHUC – Algérie. 5- Doctorante en génétique, Constantine – Algérie
Abstract
Intraductal papillary mucinous neoplasms of the pancreas (IPMNs) are rare cystic neoplasms with significant malignant potential. Treatment is primarily based on surgical resection, tailored to the patient’s radiological and clinical profile. This case report highlights a specific technical approach in the management of a complex IPMN. A 69-year-old patient was admitted for a cystic pancreatic mass associated with dilation of both the main pancreatic duct (Wirsung duct) and the common bile duct. Imaging findings were suggestive of a main-duct IPMN. Following multidisciplinary discussion, the decision was made to perform a total pancreatectomy extended to the spleen, with digestive reconstruction involving two anastomoses: a choledochojejunostomy and a gastrojejunostomy. The postoperative course was complicated by the occurrence of a digestive fistula. Histopathological analysis confirmed an intestinal-type IPMN with focal gastric differentiation, without invasion or lymph node involvement (pTis N0 R0). Although technically demanding, this surgical approach achieved complete tumor resection with functional reconstruction. It demonstrates that a personalized management strategy, guided by malignancy risk criteria, can ensure both oncological efficacy and surgical safety. The surgical management of main-duct IPMNs requires adaptation to the anatomical and pathological specificities of each patient. This case contributes to the existing literature on the management of complex IPMNs and digestive reconstruction in the context of extended resection, and underscores the importance of preserving and ligating the left gastric vein in order to avoid extended gastric resection.
Keywords: IPMN, pancreas, pancreatic surgery, total pancreatectomy, clinical case.