Two 2-0 silk stay sutures were placed figure of eight fashion in the superior and inferior margins of the pancreas beyond the staple line. This also controls the two longitudinal vessels found above and below the duct. The staple line was trimmed from the distal end of the pancreas back to clean tissue. The posterior wall of the pancreatic stump was carefully separated from the splenic vein for a distance of two centimeters to make room for the posterior wall of the anastomosis. The jejunal end was trimmed and brought through an opening in the transverse mesocolon to the left of the middle colic vessels (see lower GI bleed for colonic blood supply).
On opening the pancreatic duct, there was extensive calcified concretion within the ductal system as seen on the CT scan. The gland had a relatively firm consistency like that of a burned out chronic pancreatitis. Such a gland is more secure to sew to, with less chance of leak and fistula, but does not bode well for future function.
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