Abstract
The patient was a 78-year-old woman who was found having a 3-cm sized tumor at the pancreas head which was diagnosed as an intraductal papillary mucinous neoplasm (IPMN) of branch ducts in April 2003. Thereafter she had been followed in the clinic until May 2006, when she was admitted to the hospital because of lower abdominal pain and slight fever. An abdominal CT scan showed enlargement of the tumor and developement of a solid lesion in the cyst. ERCP revealed moniliform dilatation of the main pancreatic duct and a filling defect in the cyst which seemed to be a solid component. Intraductal ultrasonography showed a solid tumor in the cyst, and a biopsy of the tumor indicated IPMN with moderate dysplasia. Five days after ERCP, the patient developed obstructive jaundice, so that an ERBD tube was placed. After relief of obstructive jaundice, pancreatoduodenectomy was performed. Postoperatively a fistula about 1cm in diameter between a cyst and the common bile duct was disclosed in the sargical specimen. Histopathological study showed no tumor cells at the fistula.
It is known that IPMN can sometimes penetrate the adjacent organs. This paper presents a case of IPMN of the pancreas which formed a pancreatic cyst and a common bile duct fistula and developed obstructive jaundice.
