2021 Volume 36 Issue 6 Pages 377-384
Intraductal papillary mucinous neoplasms (IPMN) are known to cause fistulas to other organs such as the bile duct and duodenum. Development of a fistula from an IPMN into the bile duct often causes obstructive jaundice. We report a patient who underwent endoscopic nasobiliary drainage (ENBD) and radical resection after resolution of jaundice with regular tube lavage. An 84-year-old man presented with recurrent fevers. Based on detailed examination, he was diagnosed with obstructive jaundice caused by a fistula from an IPMN into the bile duct. Endoscopic placement of a plastic biliary stent failed to resolve the jaundice, the patient's condition worsened, and he was referred to our hospital. We replaced the plastic stent with an ENBD tube and performed lavage regularly to prevent obstruction. After resolution of the jaundice, we performed a pylorus-preserving pancreaticoduodenectomy. Based on pathological findings, the lesion was diagnosed as an intraductal papillary mucinous carcinoma. After surgery, the patient was discharged with no complications. One year postoperatively, there is no evidence of recurrence.
