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Pancreatobiliary fistula associated with an intraductal papillary-mucinous pancreatic neoplasm manifesting as obstructive jaundice: Report of a case

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Abstract

We report a pancreatobiliary fistula caused by an intraductal papillary-mucinous pancreatic neoplasm (IPMN), manifesting as obstructive jaundice. Computed tomography showed dilatation of the bile duct and main pancreatic duct, with multiple cystic masses in the head of the pancreas. Endoscopic retrograde pancreatocholangiography showed a patulous papilla with mucin secretion. Contrast enhancement outlined amorphous material obstructing the lower part of the common hepatic duct. Pancreatogram and magnetic resonance cholangiopancreatography showed diffuse dilatation of the main pancreatic duct and side branches without communication with the adjacent organs or duct. We performed pancreaticoduodenectomy for IPMN of the pancreatic head and a tumor-like lesion in the lower common bile duct (CBD). Macroscopically, impacted thick mucus protruded into the CBD from the pancreas via a pancreatobiliary fistula. Histologic examination revealed a pancreatobiliary fistula caused by intraductal papillary-mucinous carcinoma of the pancreas with mucin hypersecretion, an adenoma without interstitial infiltration, and isolated implantation of an IPMN in the bile duct mucosa around the fistula.

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Authors and Affiliations

  1. Department of Surgery, Mito Red Cross Hospital, Sannomaru, Mito, Ibaraki, 310-0011, Japan

    Ken-Ichi Okada, Takayuki Furuuchi, Tomoyuki Tamada, Takahiro Sasaki, Tatsushi Suwa, Tomoo Shatari, Yoshifumi Takenaka & Masayoshi Sakuma

  2. Department of Pathology, Mito Red Cross Hospital, Sannomaru, Mito, Ibaraki, 310-0011, Japan

    Masao Hori

Authors
  1. Ken-Ichi Okada
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  2. Takayuki Furuuchi
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  3. Tomoyuki Tamada
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  4. Takahiro Sasaki
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  5. Tatsushi Suwa
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  6. Tomoo Shatari
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  7. Yoshifumi Takenaka
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  8. Masao Hori
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  9. Masayoshi Sakuma
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Okada, KI., Furuuchi, T., Tamada, T. et al. Pancreatobiliary fistula associated with an intraductal papillary-mucinous pancreatic neoplasm manifesting as obstructive jaundice: Report of a case. Surg Today 38, 371–376 (2008). https://doi.org/10.1007/s00595-007-3630-5

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  • DOI: https://doi.org/10.1007/s00595-007-3630-5

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