Pancreatic head tumor

Abstract

Introduction: The prognosis for pancreatic cancer is poor, and early diagnosis is essential for surgical management. By comparison with its classic form, the presence of acute or chronic inflammatory signs will mask its detection and delay its diagnosis. In our case 72-year-old man presented acute abdominal pain with hight body temperature. Laboratory investigations revealed a high amylase, BilT and BilD. Ultrasounds showed dilated gallbladder with multiple stones, and dilated CBD and pancreatic duct. Pancreas size were slightly larger comparing with patient age, and irregular contour and increased parenchymal echogenicity. So, patient underwent the ERCP+CBD stenting due to obstruction of CBD. After that patient took the abdominal CECT, it showed <1.0 cm sized stent within common biliary duct, pancreas head dilation and GB multiple stones /figure 1, first line/. When patient's symptoms resolved postoperatively, patient discharged home. Follow-up appointments after ERCP+CBD stenting, patient’s amylase were stable high <268.7 UL. By the plan we removed stent after 3 months later, but patient presented symptoms, which mentioned above, so underwent the abdominal CECT again, it showed predominant hypodense mass in pancreas head with slightly dilated pancreas duct and dilated CBD /figure 1, second line/. Since the tumor can be masked by inflammation or necrosis, like the upstream atrophy by edema, secondary signs become of great importance. Dilatation of the pancreatic duct, a double biliary and pancreatic obstruction or interruption of the pancreatic duct are unusual as our case report, and should lead to considering an underlying pancreatic tumor.