Identification of intraductal papillary mucinous neoplasm by esophagogastroduodenoscopy
05 September 2013 (online)
Some reports have described identification of intraductal papillary mucinous neoplasm (IPMN) penetrating to the stomach by esophagogastroduodenoscopy (EGD)    . However, it seems that detecting an IPMN from within a postoperative pancreatogastric fistula is very rare.
A 71-year-old man presented with slight fever. He had a history of acute pancreatitis and underwent cystogastrostomy for pancreatic pseudocyst at another institution 8 years earlier. IPMN had not been detected at that time. A detailed examination was carried out, including computed tomography (CT), which revealed a large cystic tumor of the pancreatic head accompanied by a pancreatogastric fistula ([Fig. 1]). Dilatation of the main pancreatic duct was not evident on magnetic resonance cholangiopancreatography ([Fig. 2]). EGD also showed a fistula on the posterior side of the antrum ([Fig. 3]). On passing the scope through the fistula a protruding papillary tumor covered with mucus was noted ([Fig. 4]). Biopsy samples were obtained and histological examination revealed high-grade tubular adenoma. Pancreatoduodenectomy was subsequently carried out and the patient was diagnosed as having branch-type IPMN containing foci of well-differentiated tubular adenocarcinoma ([Fig. 5]). There was no evidence of local invasion or metastasis.
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