Our Summary

This research paper discusses the case of a 72-year-old man who was suffering from a buildup of fluid in the abdomen (ascites) due to a blockage in a main vein (portal vein) that can carry blood from the digestive organs to the liver. This blockage had led to a network of small veins forming (cavernomatous transformation) after he’d undergone a complex surgical procedure called the Whipple procedure, a surgery often used to treat pancreatic cancer.

The typical solution to this issue, a procedure called a transjugular intrahepatic portosystemic shunt, wasn’t possible due to the patient’s unique body structure. However, the doctors found that there was a clear passageway at the convergence of the vein of the spleen and the vein of the intestine, and that the patient no longer had the head of the pancreas after the Whipple procedure.

With these conditions, the doctors were successfully able to create a new pathway (shunt) between the spleen-intestine vein convergence and the large vein that carries blood from the lower half of the body back to the heart (caval). They did this using a method that involved going through the jugular vein in the neck and the spleen. This case study shows a promising alternative method for treating ascites when traditional methods aren’t possible.

FAQs

  1. What is a Whipple procedure and why was it performed on a 72-year-old male?
  2. What is a splenomeso-caval shunt and how does it relate to the Whipple procedure?
  3. Why was the transjugular intrahepatic portosystemic shunt not an option in this case?

Doctor’s Tip

One helpful tip a doctor might tell a patient about the Whipple procedure is to carefully follow post-operative instructions to ensure proper healing and minimize potential complications. This may include maintaining a healthy diet, avoiding heavy lifting or strenuous activities, taking prescribed medications as directed, attending follow-up appointments, and reporting any unusual symptoms or concerns to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for a Whipple procedure include those with:

  • Pancreatic cancer
  • Ampullary cancer
  • Distal bile duct cancer
  • Chronic pancreatitis
  • Pancreatic neuroendocrine tumors

Patients with benign conditions such as pancreatic cysts, benign tumors, or severe pancreatic trauma may also be candidates for a Whipple procedure. Additionally, patients with complications from previous pancreatic surgeries, such as portal vein occlusion with cavernomatous transformation, may require a Whipple procedure to address these issues.

Timeline

Before Whipple Procedure:

  1. Patient experiences symptoms of pancreatic cancer, such as jaundice, weight loss, abdominal pain, and digestive issues.
  2. Patient undergoes diagnostic tests, such as imaging scans and blood tests, to confirm the diagnosis.
  3. Patient undergoes pre-operative preparation, including consultations with a surgical team and other healthcare providers.
  4. Patient undergoes the Whipple procedure, which involves the removal of the head of the pancreas, part of the small intestine, gallbladder, and sometimes part of the stomach.

After Whipple Procedure:

  1. Patient is closely monitored in the hospital for complications, such as infection, bleeding, and digestive issues.
  2. Patient may experience pain and discomfort in the abdominal area, which is managed with pain medication.
  3. Patient gradually resumes eating and drinking, starting with clear liquids and progressing to solid foods.
  4. Patient may require additional treatments, such as chemotherapy or radiation therapy, depending on the stage and characteristics of the cancer.
  5. Patient undergoes follow-up appointments with the surgical team and oncologist to monitor recovery and address any concerns or complications.
  6. Patient may experience long-term effects of the surgery, such as changes in digestive function and nutritional needs, which may require ongoing management and support.

What to Ask Your Doctor

  1. What is the purpose of the Whipple procedure?
  2. What are the potential risks and complications associated with the Whipple procedure?
  3. How long is the recovery time after the Whipple procedure?
  4. Will I need any additional treatments or medications after the Whipple procedure?
  5. Will the Whipple procedure affect my ability to digest food or absorb nutrients?
  6. How will the Whipple procedure impact my quality of life?
  7. What follow-up care will be needed after the Whipple procedure?
  8. Are there any dietary or lifestyle changes I should make after the Whipple procedure?
  9. How long will it take for me to return to normal activities after the Whipple procedure?
  10. What are the chances of the cancer returning after the Whipple procedure?

Reference

Authors: Takahashi EA, Andrews JC. Journal: Clin Imaging. 2019 Jan-Feb;53:221-224. doi: 10.1016/j.clinimag.2018.10.019. Epub 2018 Oct 23. PMID: 30445372