Successful pancreatic duct-to-jejunum anastomosis in a patient with a double pancreatic duct: usefulness of intraoperative ultrasonography (IOUS) and IOUS-guided pancreatography.

We treated a patient with cancer of the papilla of Vater associated with an infrequent pancreatic duct course. With a preoperative endoscopic retrograde cholangiopancreatography, the presence of a double pancreatic duct was found. These ducts were bifurcated at the pancreatic body. Intraoperative ultrasonography and intraoperative ultrasonography-guided pancreatography were performed during the surgery. These procedures clarified the tumor extension and exact location of the duct bifurcation. The confirmation of the location of the duct bifurcation enabled to prevent the inadvertent suture of the second pancreatic duct or leaving the second duct without an anastomosis, which would have resulted in the leakage of the pancreatic juice and serious complications, to be avoided.