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. When conventional resection risks extensive bowel loss, ex-vivo small bowel autotransplantation offers a means to achieve R0 resection while minimizing warm ischemia. Surgical complexity is further increased in patients with prior major abdominal operations such as pancreaticoduodenectomy. 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 vessels. The tumor progressed despite chemotherapy, prompting consideration of ex-vivo small bowel autotransplantation as a definitive surgical solution. Vascular and gastrointestinal reconstruction was successfully completed despite prior Whipple surgery. Histopathological evaluation confirmed recurrence of neuroendocrine carcinoma. She had an uneventful postoperative recovery and was discharged in stable condition on postoperative day 14, with planned follow-up sessions. Conclusion Ex-vivo small bowel autotransplantation is a technically demanding but viable option for unresectable mesenteric tumors involving major vessels, even after complex prior surgery. To our knowledge, this is the first reported case of ex-vivo small bowel autotransplantation performed in a patient with prior Whipple surgery, highlighting both the technical challenges and the feasibility of this approach. Strategic procedural modifications and optimized graft preservation techniques may enhance safety and long-term outcomes.