A case of remnant pancreatic cancer with invasion to the anastomosed intestine after IPMC resection

A 73-year-old man with fever and upper abdominal pain was admitted for acute cholangitis. He had undergone pancreaticoduodenectomy for intraductal papillary mucinous carcinoma (IPMC) 19 years before and stent placement for the stenosis of the anastomosed intestinal 2 months before. Contrast-enhanced abdominal computed tomography (CE-CT) on admission revealed a thickened wall of the small intestine surrounding the stent with the dilated main pancreatic duct, and a tumor of the remnant pancreas was suspected. Stent exchange for cholangitis was failed because the enteroscope could not reach the stenotic portion. Fever and upper abdominal pain were relieved by administration of antibacterial drugs. Ultrasonography (US) revealed the wall thickening of the anastomosed intestine and percutaneous biopsy of the lesion showed adenocarcinoma. CE-CT and US suggested remnant pancreatic cancer with invasion to the anastomosed intestine. Surgical treatment could not be selected due to extension of the tumor to the retroperitoneum, and chemotherapy was performed.