Abstract
A 74-year-old male with epigastric pain was found to have an increased inflammatory response and elevated serum and urine amylase levels. The patient was diagnosed as having acute pancreatitis. Abdominal CT scan revealed dilation of the main pancreatic duct and lower portion of the bile duct, as well as a hypodensity in the tail of the pancreas. The patient developed peritoneal signs, and another abdominal CT scan was performed. The patient was diagnosed as having peritonitis due to a perforated gallbladder ; percutaneous transhepatic gall bladder drainage and abdominal drainage were required. Preoperatively, the patient was diagnosed as having an intraductal papillary mucinous neoplasm. Once the patient was stabilized, a cholecystectomy, a distal pancreatectomy, and a splenectomy were performed. The pancreatic tumor was on pathology diagnosed as an intraductal papillary-mucinous adenoma mixed type, 24 mm×21 mm in size. There are no reports of patients with an intraductal papillary mucinous neoplasm developing a perforated gallbladder. In the current patient, there was an increase in the pressure in the pancreaticobiliary ducts caused by mucus produced by the tumor, as well as cholestasis and pancreatobiliary reflux ; this could have led to the perforation.
