Carcinoma of the head of the pancreas in an annular pancreas complicated by branch duct type intraductal papillary mucinous neoplasm: A case report

Abstract

Annular pancreas is a congenital anomaly in which pancreatic parenchyma surrounds the second part of the duodenum, with a frequency of 0.015%. Pancreatic cancer is extremely rare in patients with annular pancreas. We report a patient with invasive ductal carcinoma of the head of the pancreas in an annular pancreas. A 76-year-old woman was diagnosed with branch duct intraductal papillary mucinous neoplasm and annular pancreas and was admitted with fatigue and anorexia. Laboratory data showed elevation of serum bilirubin and hepatobiliary enzymes. Contrast-enhanced CT scan revealed dilatation of the intrahepatic and common bile ducts, and showed a 2cm hypovascular tumor in the head of the pancreas. Pancreatography showed disruption of the main pancreatic duct in the head, and dilatation of the caudal main pancreatic duct. Cholangiography showed stenosis of the distal bile duct and the diagnosis was obstructive jaundice due to carcinoma of the head of the pancreas. A subtotal stomach preserving pancreaticoduodenectomy was performed. Pathology revealed invasive ductal carcinoma of the pancreas. Ph, TS2 (33mm), pT3, pN1, M0, pStage IIB.