Relapsed Acute Pancreatitis as the Initial Presentation of Pancreatic Cancer in a Young Man: A Case Report

• Published in: The Kaohsiung journal of medical sciences Vol. 26; no. 8; pp. 448 - 455
• Main Authors: Tsai, Ming-Ju, Liao, Kuo-Sheng, Shih, Paul Ming-Chen, Lee, King-Teh, Chuang, Wan-Long, Chiu, Yu-Jui, Lin, Zu-Yau
• Format: Journal Article
• Language: English
• Published: China (Republic : 1949- ) Elsevier B.V 01.08.2010; Wiley
• Subjects: Acute Disease - therapy; adenocarcinoma; Adult; Fatal Outcome; Humans; Internal Medicine; Male; pancreatic cancer; pancreatic neoplasms; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - surgery; pancreatitis; Pancreatitis - diagnosis; Pancreatitis - diagnostic imaging; Pancreatitis - pathology; Recurrence; Ultrasonography; adenocarcinoma; pancreatic cancer; pancreatitis; pancreatic neoplasms
• ISSN: 1607-551X; 2410-8650
• DOI: 10.1016/S1607-551X(10)70072-3

Abstract In this report, we describe a 31-year-old man in whom acute pancreatitis was the initial feature of a subsequently diagnosed pancreatic adenocarcinoma with multiple metastases. He initially presented at our hospital with acute pancreatitis. Abdominal ultrasonography revealed a mildly dilated pancreatic duct and an enlarged pancreatic head. Although a follow-up abdominal ultrasonography revealed a progressively dilated pancreatic duct and a progressively enlarged pancreatic head, he refused further investigation and was lost to follow-up. Four months later, he returned to our hospital with relapsed acute pancreatitis. Obstructive jaundice was noted and drainage was performed. Because choledochoplasty with multiple balloon catheters was not fully effective, biliary tract bypass surgery was carried out. Intraoperative biopsy confirmed pancreatic adenocarcinoma with multiple metastases. The patient died of massive gastrointestinal bleeding a few weeks later. To our knowledge, this is the youngest case of pancreatic cancer with the uncommon initial presentation of acute pancreatitis reported in the literature. For a patient with acute pancreatitis, particularly recurrent episodes, but with no known risk factors for pancreatitis, a pancreatic neoplasm should be considered as a potential underlying cause, even in a young man.