Context Intraductal Papillary Mucinous Neoplasm of the pancreas is an increasingly diagnosed neoplasm that rarely penetrates adjacent organs. Case report A 60 year old asymptomatic male was seen for evaluation of iron deficiency anemia. Patient was found to have a mucin secreting tumor during esophagogastroduodenoscopy. Computed tomography scan showed an enlarged pancreas with numerous focal irregularities with an ill-defined mass. Surgical resection was offered but he refused and about one year later he presented again with jaundice, abdominal pain and nausea. Magnetic resonance imaging of the abdomen showed a fistula between the pancreatic mass and the distal common bile duct. He underwent surgical resection. Histology showed an intraductal pancreatic mucinous neoplasm with foci of adenocarcinoma. Repeat esophagogastroduodenoscopy and computed tomography scans of the abdomen at one and three years showed post-operative anatomy with no tumor recurrence. Conclusion In this case an intraductal papillary mucinous neoplasm penetrated the duodenum, stomach and the common bile duct causing a large pancreaticobiliary fistula and obstructive jaundice. Despite a one year delay in surgical resection and extensive disease, our patient had an excellent long term outcome.
Drew Triplett, Mustafa Musleh, Sangeeta Agrawal