A 69-year-old man complaining of epigastric pain was transported by ambulance to our hospital. Computed tomography showed severe acute pancreatitis and he was admitted. Endoscopic retrograde cholangiopancreatography was performed because he had fever and jaundice, and it revealed that the papilla was enlarged. Biopsy specimens of the papilla were obtained and histopathological examination revealed adenocarcinoma. We inserted a biliary and pancreatic stent; however, jaundice reappeared. Endoscopic retrograde cholangiopancreatography was performed again and revealed a pancreaticoduodenal fistula with drainage. We continued conservative treatment. Subtotal stomach-preserving pancreaticoduodenectomy was performed after inflammation improved.
Spontaneous drainage from the pancreaticoduodenal fistula led to a good course of treatment for pancreatitis. Also, duodenal papillary carcinoma rarely causes pancreatitis. Searching for neoplastic lesions is important when we encounter patients with pancreatitis whose cause cannot be determined.
