{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:18:01Z","timestamp":1782901081175,"version":"3.54.5"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T00:00:00Z","timestamp":1639526400000},"content-version":"vor","delay-in-days":75,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Surg J (N Y)"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Purpose\u2003Pancreaticoduodenenctomy is a complex surgery and the sequence of steps is affected by anatomical variations involving small intestine and major vascular structures. This article depicts our approach to two such cases and highlights the importance of identifying these variations preoperatively on imaging, so as to modify the surgery plan accordingly.<\/jats:p><jats:p>\n          Cases\u2003We report following two cases of pancreatic head adenocarcinoma (1) one with incomplete intestinal rotation with a replaced right hepatic artery and (2) one with intestinal nonrotation. In both cases, the small bowel was aggregated on the right side of the abdomen, making duodenal mobilization challenging. The surgical approach was modified to prevent injury to these vessels. A superior mesenteric artery (SMA)-first approach helped in early isolation of vascular structures especially when vascular anomaly was also present. Interbowel adhesiolysis, limited kocherisation, tracing all vessels to its origin before division, paracolic anastomotic limb after a longer jejunal limb resection in nonrotation cases, and modification in retropancreatic tunnel creation are few of the key surgical adaptations.<\/jats:p><jats:p>\n          Conclusion\u2003Asymptomatic Intestinal malrotation is rare in adults and must be identified on preoperative imaging. Resultant intestinal and vascular anatomical variations need meticulous surgical planning and modification of conventional surgical approach for safe performance of PD.<\/jats:p>","DOI":"10.1055\/s-0041-1736670","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:35:19Z","timestamp":1639614919000},"page":"e301-e306","source":"Crossref","is-referenced-by-count":4,"title":["Anatomical Challenges during Pancreaticoduodenectomy for Adenocarcinoma Head of Pancreas in Presence of Intestinal Rotation Abnormalities: A Report of Two Cases"],"prefix":"10.1055","volume":"07","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9307-5479","authenticated-orcid":false,"given":"Gunjan S.","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, S. L. Raheja (A Fortis Associate) Hospital, Mahim (West), Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandip","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Lilavati Hospital and Research Centre, Bandra (West), Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7172-7798","authenticated-orcid":false,"given":"Prasad M.","family":"Pande","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, S. L. Raheja (A Fortis Associate) Hospital, Mahim (West), Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2162-0060","authenticated-orcid":false,"given":"Prasad K.","family":"Wagle","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Bandra West, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,12,15]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s12664-017-0770-4","article-title":"The role of preoperative C-reactive protein and procalcitonin as predictors of post-pancreaticoduodenectomy infective complications: a prospective observational study","volume":"36","author":"V Mansukhani","year":"2017","journal-title":"Indian J Gastroenterol"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/00015458.2016.1272251","article-title":"Intestinal malrotation and replaced common hepatic artery during duodenopancreatectomy: a case report","volume":"117","author":"A Schank","year":"2017","journal-title":"Acta Chir Belg"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/01.mpa.0000181486.42646.4e","article-title":"Pancreaticoduodenectomy in adults with congenital intestinal rotation disorders","volume":"31","author":"R Mateo","year":"2005","journal-title":"Pancreas"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1007\/s12029-018-0117-0","article-title":"Pancreaticoduodenectomy with replaced common hepatic artery and portal vein reconstruction in primary carcinoma duodenum: a case report and literature review","volume":"50","author":"G S Desai","year":"2019","journal-title":"J Gastrointest Cancer"},{"issue":"10","key":"ref5","first-page":"765","article-title":"Reversed rotation of midgut which caused problems during Whipple's procedure","volume":"161","author":"P Jagannath","year":"1995","journal-title":"Eur J Surg"},{"issue":"04","key":"ref6","first-page":"239","article-title":"The presentation of malrotation of the intestine in adults","volume":"72","author":"H W Gilbert","year":"1990","journal-title":"Ann R Coll Surg Engl"},{"issue":"05","key":"ref7","first-page":"445","article-title":"Pancreatico-duodenectomy in incomplete bowel rotation, anatomical peculiarities","volume":"54","author":"B T Daniels","year":"1957","journal-title":"Rocky Mt Med J"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.2214\/ajr.179.6.1791429","article-title":"Intestinal malrotation in adolescents and adults: spectrum of clinical and imaging features","volume":"179","author":"P J Pickhardt","year":"2002","journal-title":"AJR Am J Roentgenol"},{"issue":"49","key":"ref9","doi-asserted-by":"crossref","first-page":"e8599","DOI":"10.1097\/MD.0000000000008599","article-title":"Case report of intestinal non-rotation, heterotaxy, and polysplenia in a patient with pancreatic cancer","volume":"96","author":"S Pagkratis","year":"2017","journal-title":"Medicine (Baltimore)"},{"issue":"08","key":"ref10","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1002\/bjs.8763","article-title":"\u2018Artery-first\u2019 approaches to pancreatoduodenectomy","volume":"99","author":"P Sanjay","year":"2012","journal-title":"Br J Surg"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1089\/pancan.2018.0005","article-title":"Duodenal adenocarcinoma in a patient with partial intestinal malrotation","volume":"4","author":"W T Li","year":"2018","journal-title":"J Pancreat Cancer"},{"issue":"11","key":"ref12","first-page":"237","article-title":"Pancreaticoduodenectomy in the setting of intestinal malrotation","volume":"70","author":"T P Plackett","year":"2011","journal-title":"Hawaii Med J"}],"container-title":["The Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0041-1736670.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T00:35:30Z","timestamp":1639614930000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0041-1736670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":12,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2021,10,5]]},"published-print":{"date-parts":[[2021,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0041-1736670","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2378-5128","2378-5136"],"issn-type":[{"value":"2378-5128","type":"print"},{"value":"2378-5136","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}