Abstract
A 58-year-old woman was referred to our hospital complaining of left flank pain, left thigh edema and high fever.
Laboratory findings revealed elevated inflammatory markers and elevated serum amylase, with normal serum tumor marker levels. Enhanced CT showed dilatation of the main pancreatic duct and a large retroperitoneal fluid collection extending from the left perirenal space to around the femoral vessels. No evidence of pancreatic tumor was detectable by enhanced CT, MRCP or US. The drainage from the retroperitoneal fluid was pancreatic fluid. Upper gastrointestinal endoscopic examination incidentally revealed carcinoma of the papilla of Vater. Therefore, the patient was diagnosed as having carcinoma of the papilla of Vater with pancreatitis and retroperitoneal fluid collection due to obstruction of the main pancreatic duct, and treated by subtotal stomach-preserving pancreaticoduodenectomy.
Histopathological examination of the resected specimen revealed pancreatic ductal adenocarcinoma, pT3, pN1a, pM0, Stage IIB. Pancreatic head carcinoma is often diagnosed in patients with non-specific symptoms such as epigastralgia, back pain, and jaundice, while initial presentation with a large retroperitoneal fluid collection is rather rare. Herein, we report one such case, with a review of the literature.
