Pancreatic head resection with segmental duodenectomy for the management of a solid pseudopapillary neoplasm of the pancreatic uncinate process: a case report

Introduction Solid pseudopapillary neoplasm (SPN) is a rare low-grade malignant pancreatic tumor that predominantly affects young women. Pancreatic head resection with segmental duodenectomy (PHRSD) has been rarely reported in pediatric patients with SPN of the pancreatic head and may offer advantages in preserving postoperative pancreatic and gastrointestinal function. Case presentation A 12-year-old girl presented with persistent abdominal pain lasting for one month. Contrast-enhanced computed tomography revealed a 5-cm mass in the pancreatic uncinate process, and she was referred to our institution for further evaluation. Endoscopic ultrasonography demonstrated a well-circumscribed tumor in close proximity to the main pancreatic duct and compressing the duodenum. Based on these imaging findings, SPN was suspected. Because the tumor was adjacent to the main pancreatic duct, tumor enucleation was considered inappropriate because of the risk of ductal injury, and PHRSD was performed to preserve as much of the duodenum as possible. Intraoperative indocyanine green (ICG) fluorescence imaging confirmed adequate perfusion of the remnant duodenum. Histopathological analysis confirmed SPN with negative surgical margins. The postoperative course was uneventful, with no clinically relevant postoperative complications, and the patient was discharged on postoperative day 17. At the 1-year follow-up, she remained free of recurrence, weight loss, and other postoperative complications. Conclusions PHRSD may be a safe and effective alternative to pancreaticoduodenectomy in children with SPN located in the pancreatic uncinate process. Intraoperative ICG fluorescence imaging may be useful for assessing duodenal perfusion during PHRSD.