2020 Volume 53 Issue 8 Pages 657-664
An 85-year-old woman with abdominal discomfort was referred to our hospital. CT showed multiple, 70-mm, cystic lesions in the pancreas, dilatation of the main pancreatic duct, and continuity with the transverse colon. On ERCP, the major duodenal papilla was open, there was leakage of mucus, and a papillary tumor was found in the main pancreatic duct. Ultrasonic endoscopy showed cystic lesions in the pancreas and multiple enhanced mural nodules. A biopsy led to diagnosis of intraductal papillary mucinous carcinoma (IPMC). Diffusion-weighted MRI showed a diffuse high signal and a delayed contrast effect in the pancreatic parenchyma, and diffuse invasion of cancer was suspected. Colonoscopy showed a fistula in the transverse colon. The patient was diagnosed with IPMC penetrating the colon, and total pancreatectomy and partial resection of the colon were performed. Intraductal papillary mucinous neoplasms often penetrate other organs, but reports of colon penetration are rare. Here, we describe a case of IPMC penetrating the colon, along with a literature review of the surgical indication for this condition in elderly patients.
