Acute obstructive jaundice: a possible clinical manifestation of IPMT Case report and review of the literature

Abstract

INTRODUCTION: Pancreatic masses causing acute obstructive jaundice still pose diagnostic difficulties and their characterization can often be complex as there is significant overlap in their imaging features.

CASE REPORT: We describe a case of Intraductal Papillary Mucinous Tumor (IPMT) presenting with acute obstructive jaundice in a patient with history of recurrent mild pancreatitis. Clinical evaluation, abdominal ultrasonography (US) and CT-scan posed suspicion of adenocarcinoma with cystic degeneration of the pancreatic head or mucinous cystadenocarcinoma; magnetic resonance (MR) with magnetic resonance cholangiopancreatography (MRCP) demonstrated the communication of the mass with the main pancreatic duct, posing differential diagnosis between main-duct-IPMT and mucinous cystadenocarcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated the presence of a mucussecreting lesion inside duodenum and duodenal biopsies showed no evidence of neoplastic cells.

RESULTS: The patient underwent spleen preserving total pancreatectomy that led to histological diagnosis of intraductal papillary mucinous with carcinoma in situ.

DISCUSSION: The international guidelines for management of IPMT, reported in 2006 and revised in 2012, establish that the resectability and the absence of an invasive carcinoma are the most important prognostic factors in IPMT. Therefore an early diagnosis and a radical resection are crucial to improve the patient survival and reduce the recurrence rate.

CONCLUSION: When an IPMT is suspected, the imaging modalities are essential to pose the diagnosis, maximise the chance to select the right surgical candidate and to perform the best treatment for each patient.