Pancreatic cancer masquerading as ischemic enteritis on endoscopy

Pancreatic tumors usually produce painless jaundice. Other associated symptoms may be secondary, from a direct extension of the tumor, resulting in bowel obstruction. It is extremely rare that pancreatic malignancy presents with ischemic enteritis by invasion of the major arteries, and no report has...

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Bibliographic Details
Published in:JGH open 2021-01, Vol.5 (1), p.157-159
Main Authors: Aguila, Enrik John T, Francisco, Carlos Paolo D, Co, Jonard T
Format: Article
Language:English
Subjects:
Abdomen
Biopsy
Case Report
Case Reports
Disease
Endoscopy
Intestinal obstruction
Ischemia
ischemic enteritis
Laparotomy
Medical imaging
pancreas
Pancreatic cancer
Small intestine
Tumors
Ultrasonic imaging
Veins & arteries
Vomiting
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Summary:Pancreatic tumors usually produce painless jaundice. Other associated symptoms may be secondary, from a direct extension of the tumor, resulting in bowel obstruction. It is extremely rare that pancreatic malignancy presents with ischemic enteritis by invasion of the major arteries, and no report has documented it endoscopically. We present a rare case of pancreatic adenocarcinoma masquerading as ischemic enteritis diagnosed on enteroscopy and endoscopic ultrasound. An initial computed tomography (CT) scan performed in another hospital showed long segmental wall thickening involving the third part of the duodenum to the proximal segment of the jejunum. The patient was referred to our institution for enteroscopy, which showed a poorly distensible third part of the duodenum with purplish mucosa starting at the fourth part of the duodenum until the proximal jejunum. With suspicion of ischemic enteritis, a mesenteric CT angiography was performed, which showed a long segment circumferential wall thickening of the duodenum to jejunum with fullness of the pancreatic head and uncinate process that encases the superior mesenteric artery. Endoscopic ultrasound (EUS) showed a hypoechoic lesion at the head of the pancreas. EUS‐guided fine‐needle biopsy was performed, which revealed pancreatic adenocarcinoma on histopathology. Despite being a part of the criteria for unresectability of pancreatic malignancies, only very few published reports discuss the sequelae of pancreatic cancer invading the mesenteric vessels. This case report describes a rare case of a metastatic pancreatic disease causing vascular invasion, leading to ischemic enteritis detected endoscopically.
ISSN:2397-9070
2397-9070
DOI:10.1002/jgh3.12421