2018 Volume 43 Issue 2 Pages 258-264
We report a rare case of a bleeding remnant pancreatic cancer. An 83-year-old woman was admitted to our hospital with anemia and melena. She had a past medical history of pancreatodenectomy for cancer of the ampulla of Vater 8 years earlier and a right hemicolectomy for colon cancer 2 years earlier. The cancers of the ampulla of Vater and colon were histologically diagnosed as well- and moderately-differentiated tubular adenocarcinomas, respectively (Stage ⅠA and Stage ⅡB). Abdominal CT showed a tumor on the main pancreatic duct of the remnant pancreas. Double-balloon enteroscopy revealed a bleeding tumor at the anastomotic site of the pancreaticojejunostomy. The biopsied specimen was histologically diagnosed as a well-differentiated tubular adenocarcinoma showing morphological features similar to the cancer of the ampulla of Vater. In lieu of surgery, which the patient refused, we performed transcatheter arterial embolization to control the bleeding. The surgery was successful and the patient was discharged 6 days after embolization. According to the literature, 6 Japanese patients with remnant pancreatic cancer after pancreatodenectomy for cancer of the papilla of vater went on to develop pancreatic cancer 5 years or later after the first operation. Long-term follow-up of patients undergoing pancreatodenectomy is recommended.
