Laparoscopic Spleen-Preserving Distal Pancreatectomy for Mucinous Cystic Neoplasm With Unexpected Immunoglobulin G4-Related Periarteritis of the Splenic Artery: A Case Report.

Unexpected vascular lesions may complicate standard laparoscopic pancreatic procedures. We report a case of mucinous cystic neoplasm (MCN) treated with laparoscopic spleen-preserving distal pancreatectomy (LSPDP) in which unrecognized immunoglobulin G4 (IgG4)-related periarteritis of the splenic artery caused difficulty during vascular division. A 76-year-old woman underwent LSPDP for MCN. Preoperative computed tomography demonstrated circumferential soft-tissue thickening along the splenic artery. Intraoperatively, the splenic artery was deeply embedded within the pancreatic parenchyma, making the Kimura technique impractical; therefore, the Warshaw technique was selected. However, the splenic artery demonstrated marked circumferential wall thickening, precluding safe division with ligation or clipping alone. The artery was ultimately divided using a vascular stapler. Histopathological examination revealed low-grade MCN and IgG4-related periarteritis involving the splenic artery. This case highlights that IgG4-related periarteritis should be considered when unexplained perivascular soft-tissue thickening is identified preoperatively, as it may significantly alter intraoperative strategy during LSPDP.
Cancer
Cardiovascular diseases
Care/Management

Authors

Lee Lee, Nanno Nanno, Ishida Ishida, Mizumoto Mizumoto, Ueda Ueda, Nakamura Nakamura, Okawa Okawa, Hamano Hamano, Yokota Yokota, Akita Akita, Arai Arai, Yoshida Yoshida, Urade Urade, Fukushima Fukushima, Asari Asari, Kido Kido, Masuda Masuda, Kodama Kodama, Komatsu Komatsu
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