Ex-vivo small bowel auto-transplantation with a prior pancreaticoduodenectomy (Whipple's procedure): a report of a rare case and review of literature.

BACKGROUND: Mesenteric tumors involving the superior mesenteric vessels are rare and challenging to treat, particularly in patients with prior complex abdominal surgery. When conventional resection risks extensive bowel loss, ex-vivo small bowel autotransplantation (EV-SBAT) offers a means to achieve R0 resection while minimizing warm ischemia. Evidence supporting its feasibility after pancreaticoduodenectomy remains extremely limited. CASE PRESENTATION: A 38-year-old woman with a history of pancreaticoduodenectomy presented with vague and persistent mid-abdominal pain. CT scan revealed a 134 × 76 × 145 mm mesenteric mass encasing the superior mesenteric artery and vein, with progression despite systemic chemotherapy and no evidence of distant metastasis. Given the need for R0 resection and lack of alternative curative options, a multidisciplinary team elected to perform EV-SBAT. Tumor resection, vascular, and gastrointestinal reconstruction were successfully achieved despite surgically altered anatomy. She was discharged in stable condition on postoperative day 14, and no radiological evidence of recurrence at 6-month follow-up. CONCLUSION: This case demonstrates that EV-SBAT is a feasible and rational surgical strategy for selected patients with locally advanced mesenteric tumors, even after prior pancreaticoduodenectomy. To our knowledge, this is the first reported case of EV-SBAT performed in a patient with prior Whipple surgery, highlighting both the technical challenges and the feasibility of this approach. Careful patient selection, multidisciplinary decision-making, and meticulous operative planning are essential to achieving acceptable outcomes in this highly complex setting.