IPMN with Unusual Endoscopic Appearance and Obstructive Jaundice

Introduction: An intraductal papillary mucinous neoplasm (IPMN) is a potentially malignant cystic tumor. The characteristic feature is an excessive papillary proliferation of mucin-producing epithelial cells. IPMN can have different degrees of dysplasia and is accompanied by cystic dilation of the main pancreatic-duct (MPD) or side branch. We report a case of an IPMN that has penetrated the stomach and duodenum with obstructive jaundice.

Case report: A 59-year-old male patient, with history of ethanol related chronic-pancreatitis and past cysto-gastrostomy, presented with chronic abdominal pain for last 10 months and jaundice for last 2 months with unintentional weight loss, decreased appetite and fatigue. On examination found to have mild tenderness in epigastric region with icterus. CECT abdomen showed features of chronic calcific-pancreatitis with cystic collection with dilated CBD and mesenteric lymphadenopathy. On endoscopy found to have pancreatico-gastric fistula and pancreatico-duodenal fistula with fish mouth appearance of papilla and oozing mucus, on evaluation it was found to be IPMN and obstructive jaundice secondary to cystic compression/mucin blocking CBD and patient was sent for surgical resection.

Figure 1

Conclusion: This case report provides evidence for the possibility of IPMN becoming complicated with pancreatico-gastric and duodenal fistula. Many reports on IPMN of the pancreas have been published but simultaneous gastric and duodenal invasion is rare. Given the endoscopic appearance and cyst fluid analysis, it shows that in our case a IPMN formed a pancreatico-gastric and pancreatico duodenal fistula with obstructive jaundice.

Publication History

Article published online:
22 April 2024