1. Presented by Peter Illei, M.D. and prepared by Jeffrey T. Schowinsky, M.D.

This 55 year old female patient with locally advanced pancreatic cancer presented 6 month ago with a pancreatic mass with pancreatic duct dilatation and encasement of the superior mesenteric vein and splenic artery. Ultrasound guided fine needle aspiration revealed adenocarcinoma. Her tumor decreased in size after receiving chemo radiation therapy. Preoperative imaging demonstrated occlusion of the portal confluence at the site of portal vein and superior mesenteric vein. Her chief complaints were nausea and vomiting. She underwent a total pancreatectomy with splenectomy.

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