Sister Joseph nodule from a colon cancer in a paraumbilical hernial sac

a pyloric ring-preserving pancreatic head resection was performed. During operation, we found the pancreas anomaly that the uncinate process of the pancreas head was elongated towards the neck below the SMV and has become fused to the neck. The operative procedure was difficult to perform because of the complicated anatomy of the elongated uncinate process between SMV and superior mesenteric artery (Fig. 1). There was no differentiating point in the pancreatic parenchyma between the elongated uncinate process and the neck. The uncinate process of the pancreas surrounded the SMV. Therefore, we resected the elongated pancreas at the fusion site dorsal to the pancreas neck with careful exfoliation procedure, and added pancreas head resection at the pancreatic neck. We reconstructed the remaining pancreas by Child’s method. The post-operative course was uneventful. During fetal development, the pancreas is formed from two primordia, the ventral and dorsal. The ventral pancreas rotates to fuse with the dorsal pancreas. So, in our case, the ventral pancreas developed and hypertrophied towards the left side behind the SMV and fused with the dorsal pancreas. Then, annular pancreas surrounding the SMV might be formed. We reviewed the magnetic resonance images after operation and found the anomaly by the sequential reading of each slice. The elongated uncinate process was depicted in an obliquely left lateral direction. To our knowledge, such an anomaly, involving an annular uncinate process of the pancreas surrounding the SMV, has only been described in one case. Because of the low incidence of this disorder, we could not pay much attention to it. However, in preparing routine surgery for pancreas, perhaps careful attention should be given to such structural abnormalities.