Solid and papillary epithelial neoplasm (SPEN) of the pancreas is a rare tumour
occurring mainly in adolescent girls and young women. Local growth is slow,
and metastasis (mainly hepatic) are rare. The prognosis is usually good,
provided complete surgical excision is achieved. We report on a 13 years old
girl who discovered an abdominal mass by auto-palpation. Initial imaging workup
showed a 7 cm diameter partially cystic mass in the pancreatic head,
displacing the duodenum, with normal tumour markers, and no extrapancreatic
extension. Duodenal duplication was suspected, but SPEN of the
pancreas was eventually diagnosed by operative findings and surgical biopsy.
The child underwent secondary total excision of the lesion by pyloruspreserving
pancreaticoduodenectomy. Intra-operative frozen sections of the
pancreas cut surface were free of tumour. Prior to digestive reconstruction, in
order to avoid any intestinal traction or twist, the distal duodenum and jejunum
were transposed behind the superior mesenteric vessels, small bowel was
placed on the right side and colon on the left side of the abdomen (like after
cure of midgut malrotation), with appendectomy. Bilio- and pancreaticodigestive
anastomoses were performed on two separate Roux en Y loops,
placed behind the jejunal loop anastomosed to the first duodenum. Post
operative course was uneventful. Histology confirmed complete tumour
excision, and the girl is doing well 10 months after surgery. This technique
allowed a safe reconstruction of separate alimentary, pancreatic and biliary
conduits after removal of a large SPEN of the pancreatic head, avoiding any
traction or twist of the intestinal loops with minimal additional intestinal
dissection as compared to classic techniques.