Total Pancreatectomy for Malignant Intraductal Papillary Mucinous Neoplasm (IPMN) Complicated by Gastropancreatic Fistulae

Background. Intraductal papillary mucinous neoplasms (IPMN) of the pancreas complicated by fistula formation to adjacent organs are an uncommon phenomenon. We present an IPMN of the pancreas with malignant transformation and multiple fistulae to the stomach and duodenum. Case Presentation. A 50-year...

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Bibliographic Details
Published in:Case reports in surgery 2020, Vol.2020 (2020), p.1-4
Main Authors: Fernandopulle, Nilesh, Jayarajah, Umesh, Wijerathne, Pradeep, Basnayake, Oshan, Sivaganesh, Sivasuriya
Format: Article
Language:English
Subjects:
Accuracy
Adenocarcinoma
Antigens
Case Report
Case reports
Cellular biology
Chemotherapy
Computed tomography
Cytology
Duodenum
Dysplasia
Endoscopy
Fistula
Fistulae
Gastrectomy
Histology
Intestine
Magnetic resonance imaging
Medical research
Medicine, Experimental
Neoplasia
Neoplasms
Nutritional status
Organs
Pain
Pancreas
Pancreatectomy
Pancreatic cancer
Pancreatitis
Parenchyma
Splenectomy
Stomach
Surgery
Surveillance
Tumors
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Summary:Background. Intraductal papillary mucinous neoplasms (IPMN) of the pancreas complicated by fistula formation to adjacent organs are an uncommon phenomenon. We present an IPMN of the pancreas with malignant transformation and multiple fistulae to the stomach and duodenum. Case Presentation. A 50-year-old female was referred for investigation of recent epigastric pain and a past history of recurrent pancreatitis. Imaging with computed tomography showed a gross dilatation of the entire pancreatic duct with a heterogeneous enhancement of the periductal parenchyma. A passage of oral contrast was noted from the greater curvature and pylorus of the stomach into the dilated duct suggestive of fistulae formation. Gastroduodenoscopy demonstrated these fistulae in the stomach and the proximal duodenum and an exophytic growth at the ampulla obliterating the view of ampullary opening. Endosonography- (EUS-) guided fine-needle aspiration cytology (FNAC) showed cells with high-grade atypia. A total pancreatectomy, distal gastrectomy, and splenectomy were performed, and recovery was uneventful. Histology revealed a ductal adenocarcinoma arising from an intestinal type intraductal papillary mucinous neoplasm with high-grade dysplasia. A year and a half after surgery, she is healthy with good glycaemic control and nutritional status. Conclusion. This case highlights the importance investigating patients for the aetiology in recurrent acute pancreatitis and their follow-up. Awareness of cystic pancreatic neoplasms including IPMN is important to avoid misdiagnosis or delayed diagnosis. Referral of these patients to centres with facilities for multidisciplinary input and specialised management is strongly recommended.
ISSN:2090-6900
2090-6919
DOI:10.1155/2020/8547526