review of literature on clinical pancreatology - The Pancreapedia

anecdotal reports <strong>of</strong> pancreatic resection for pancreatic protrusion after penetratingabdominal trauma were reported. Distal pancreatectomy was the first reported anatomicresection <strong>of</strong> pancreatic parenchyma in humans by Friedrich Trendelenburg <strong>of</strong> Bonn,Germany, on July 16, 1882. The patient was a 44 year old female with a giant mass in theleft upper quadrant. Trendelenburg resected the retroperitoneal mass along with thepancreatic tail from which the mass seemed to originate. The operation was complicated bya splenic injury requiring splenectomy. The proximal pancreatic remnant was closed withsuture ligature. Histology revealed a spindel cell carcinoma. The postoperative course wascomplicated by wound infection and malnutrition. The patient insisted on going home butdied there later <strong>of</strong> respiratory failure. By 1910, distal pancreatectomy was reported in anotherfive patients, two <strong>of</strong> who died postoperatively.EnucleationThe first reported enucleation <strong>of</strong> pancreatic mass was performed by Giuseppe Ruggi <strong>of</strong>Bologna on September 4, 1889. The patient was a 50 year female with physical findings <strong>of</strong> alarge, mobile mass in the upper abdomen associated with epigastric disdomfort, constipationand malaise. At operation, ascites as well as a large s<strong>of</strong>t tumor in proximity to the head <strong>of</strong>pancreas was fond. Histology showed an adenocarcinoma with adjacent glandular tissue.Billroth, Codivilla and HalstedtSeveral reports suggest that Theodor Billroth <strong>of</strong> Vienna undertook a presumed totalpancreatectomy in 1884 with good outcome (anectotal by Arthur William Mayo Robson in aspeech given to an international medical Congress in 1990). In June 5, 1885, Billroth alsoperformed excision <strong>of</strong> a large pancreatic cysta originating from the body <strong>of</strong> pancreas, almostcompletely replacing it. Along with resection <strong>of</strong> the atrophic pancreas body, Billroth resectedthe splenic vessels, which was not recognized until after the surgery. The transectedpancreas was not closed. This case represent the first reported true anatomic centralpancreatic resection.A landmark in pancreatic surgery was when Allesandro Codivilla <strong>of</strong> Imola, Italy, performedthe first pancreatoduodenectomy on Februari 9, 1898. Codivilla never published the case,but his successor Bartolo Del Monte did, which was brought to attention by Louis Sauve in1908. Codivilla operated on a 46 year old male who presented with 20 day history <strong>of</strong>epigastric distension and vomiting. On exploration he found a cancer involving stomach andpancreas and did distal gastrectomy, resection <strong>of</strong> portion <strong>of</strong> duodenum with head <strong>of</strong>pancreas and distal bile duct. The common bile duct and distal duodenal stump wereoversewn. Intestinal continuity was established by a Roux-en-Y gastrojejunostomy andcholecystojejunostomy over a Murphy’s buttons. The patient developed steatorrhea and died<strong>of</strong> cachexia 18 days after the operation.On February 14, 1898, William Stewart Halsted undertook the first resection <strong>of</strong> an ampullarytumor in a 60 year old female with a six month history <strong>of</strong> painless jaundice, gallbladderdistension and hepatomegaly. The operation included common bile duct exploration,transduodenal papillectomy with reanastomosis <strong>of</strong> pancreatic and bile duct and tubecholecystectomy. Three months later the patient developed jaundice on removal <strong>of</strong> tubecholecystostomy and cholecystoduodenostomy was done for terminal biliary stenosis.Biliary-enteric anastomosisThe concept <strong>of</strong> bilioenteric drainage was introduced in 1880 when Theodor Billroth’s formerstudent Alexander von Winiwarter performed a cholecystocolostomy which was later revisedto a cholecystojejunostomy. A successful cholecystojejunostomy in a patient with pancreatic