Abstract
Cholangiocarcinoma is a rare cause of acute pancreatitis. We herein report a case of distal cholangiocarcinoma presenting as acute pancreatitis. A 65-year-old woman was admitted to an affiliated hospital for treatment of acute pancreatitis, which was resistant to conservative management and recurred following dietary intakes. ERCP depicted strictures of both the main pancreatic and distal bile ducts within the head of the pancreas; the patency of the minor duodenal papilla was obscure. Computed tomography (CT) scan of the abdomen disclosed dilatation of the main pancreatic duct and some pseudocysts in the body and tail of the pancreas; no mass was depicted in the head of the pancreas. A diagnosis of idiopathic pancreatitis with strictures of both the main pancreatic and distal bile ducts was made. As the pancreatitis was resistant to conservative management and the concomitance of small pancreatic cancer could not be ruled out, a Whipple pancreaticoduodenectomy was performed. Histologic examination of the resected specimen revealed a distal cholangiocarcinoma, measuring 2.4×2.0 cm, with marked pancreatic invasion. Although the tumor invaded the main pancreatic duct within the head of the pancreas, the ampulla of Vater was not involved. The above findings suggest that the acute pancreatitis in this case was attributable to increased intraductal pressure due to involvement of the main pancreatic duct by a distal cholangiocarcinoma.
