Clinical presentation
A 66‐year‐old man presented to our institution for evaluation of the pancreatic system. His medical history showed that he had undergone distal pancreatectomy to treat intraductal papillary mucinous neoplasm 44 months earlier. His condition took an uneventful postoperative course until computed tomography showed a dilated main duct of the residual pancreas on follow‐up series. On physical examination, there were no remarkable findings in the epigastric area. Blood examinations including tumour markers showed normal values, with the exception of amylase (1439 IU/l), lipase (177 IU/l) and tripsin (990 ng/ml) concentration levels. Endoscopic retrograde pancreatography showed diffuse dilatation of the main duct with numerous filling defects (fig 1). Mucin was observed extruding through the bulging papilla of the Vater. Contrast‐enhanced ultrasound showed a mass at the distal part in the dilated main duct (fig 2). No other obvious enhancements were identified in the duct.
Figure 1 Endoscopic retrograde pancreatogram showing numerous filling defects in the dilated main duct.
Figure 2 Contrast‐enhanced ultrasound showing a papillary mass at the distal part in the dilated main pancreatic duct (arrow).
Question
What do these findings suggest as the diagnosis?
See page 1730 for answer
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