1B: Anvil of the circular stapler placed in the duodenum (blue arrow); 1C: passing the shaft of circular stapler through the open end of the stomach closer to the greater curvature;1D: Firing of the stapler to create side-to-end gastroduodenal anastomosis between posterior wall of stomach
and end of the duodenum; 1E: Closure of the open end of stomach with a linear cutter; 1F: Intraoperative photograph showing the stapled side-to-end gastroduodenal anastomosis (yellow arrow); 1G: Intraoperative photograph showing the closed cut end of the stomach (yellow arrows) which has been inverted with interrupted sero-muscular stitches.
Pancreaticogastric anastomoses in our cases was undertaken as; Pancreatic stump was anastomosed with posterior wall of stomach
. After preparing the pancreatic stump, anterior capsule of pancreas was sutured with posterior wall of stomach
, using 3.0 PDS interrupted sutures.
High resolution computed tomography (HRCT) scan chest done revealed a hypodense area measuring 3x4.1cm along the posterior wall of stomach
, bulging into the stomach lumen (fig-1).
A 11 x 10 cm mass was also noted in the retroperitoneum posterior to head of pancreas, attached to posterior wall of stomach
and involving the duodenum.
CT demonstrated a large well defined soft tissue attenuation mass showing central necrotic area and homogeuous nodular enhancement in lesser sac in relation to posterior wall of stomach
suggesting possibility of GIST.