A Novel “Salvage” Indication to Intestinal Derotation Procedure: Reconstruction after Duodenopancreatectomy

PATIENT Male, 77. FINAL DIAGNOSIS Pancreatic tumor. SYMPTOMS Jaundice. MEDICATION -. CLINICAL PROCEDURE Intestinal derotation procedure. SPECIALTY General surgery. OBJECTIVE Rare disease. BACKGROUND The purpose of the present paper is to stress the relevance for surgeons of being familiar with the procedure of intestinal derotation. This procedure is usually ignored by atlases of surgical technique and only few dedicated papers have been published since its first descriptions both in the U.S. and Europe more than 50 yrs ago. CASE REPORT The occasion for this message has been provided by a recent application of this procedure, which has also provided a brand new indication to it. In the case which is reported in the paper the reconstruction, after the resection phase of Whipple procedure, appeared impossible. As a matter of fact, a lipomatosis of the jejunal mesentery reaching up the vasa recta made impossible to raise up the jejunum in order to perform anastomoses with the remaining pancreas and the bile duct. After a minute in which we felt lost, intestinal derotation solved the problem. CONCLUSIONS In conclusion, intestinal derotation represents a valuable technical tool, which in very selected cases may be helpful in solving otherwise insoluble surgical problems. Therefore, it seems to be a necessary part of the armamentarium of any good surgeon.