A case of unresectable pancreatic tail cancer with HHS due to ileus

Abstract

 A 71‐year‐old female with type II diabetes mellitus presented with back pain. Abdominal CT and MRI revealed unresectable pancreatic tail cancer and a metastatic hepatic tumor. First‐line chemotherapy was started, but progressive disease（PD）of the metastatic hepatic tumor was noted after 8 months. Second‐line chemotherapy was then started, but she was diagnosed with PD of the primary tumor after 3 months. At 1 year and 2 months after the initial diagnosis, she presented with abdominal pain. We performed transverse colostomy and loop enterostomy as emergency surgery under a diagnosis of ileus due to direct invasion by pancreatic tail cancer. On postoperative day 0（0 POD）after the operation, she developed septic shock, disseminated intravascular coagulation（DIC）and hyperosmolar hyperglycemic syndrome（HHS）．The administration of thrombomodulin alfa, bolus dose of saline and continuous intravenous injection of insulin resolved septic shock and DIC on 7 POD, and HHS on 14 POD. We report a case of unresectable pancreatic tail cancer with HHS due to ileus and direct invasion, with a review of the literature.