Intraductal papillary mucinous neoplasms (IPMNs) are mucin secreting cystic neoplasm of pancreas.
science
Description
Introduction
Intraductal
papillary mucinous neoplasms (IPMNs) are mucin secreting cystic neoplasm of
pancreas. They comprise 20-30% of all cystic tumors of pancreas with a male
predominance and a peak incidence in 6th-7th decade.1
They have a malignant potential. They are located predominantly in head of
pancreas and around 40% of them can be multifocal.2 They are usually
localized to the pancreas but occasionally can involve surrounding structures (1.9-6.6%),
like bile duct and duodenum, and are labelled as IPMN with invasion (the term
malignant IPMN is discouraged).3
It is usually
diagnosed on CT/MRI as a macrocystic lesion with or without mural nodule along
with dilated PD and/or side branches. On ERCP the pathognomonic finding is
patulous papillary orifice with mucin extruding from in and IPMN communicating
with MPD.4
Most common
presentation is pain abdomen and weight loss (75%) followed by acute/recurrent
pancreatitis. Jaundice as a manifestation of IPMN is not common (4.5%). It can
present as jaundice as a result of invasion of CBD resulting in stricture
formation or uncommonly as a result of fistulizing to CBD with resultant
obstruction of CBD by thick mucin secreted by this tumor. IPMN presenting as
jaundice is a poor prognostic sign.1,5
As only few cases
(around 23) of IPMN fistulizing into CBD are reported in literature. We are presenting
our experience in dealing a rare case of obstructive jaundice caused by IPMN
fistulizing into CBD, highlighting the difficulties faced in managing such case
because of repeated failures to achieve adequate biliary drainage by thick
mucin and what can be the optimum management in such cases.
