147 Walled- off pancreatic necrosis mimicking a pancreatic cancer

Abstract

Abstract Introduction Walled-off pancreatic necrosis is a late complication of acute pancreatitis and can mimic a pancreatic cancer. Case Summary A 20 years old male patient was referred to us with a suspicion of pancreatic mass. He gave an inconsistent history of pain epigastrium and jaundice about 3 months back. An ultrasound abdomen showed a solid mass measuring about 47 x 52mm in head of pancreas having enhanced vascularity on doppler. Computed tomography scan done showed a mass lesion of 5cm in head of páncreas, solid and enhancing in nature with no separation from duodenum. Based on radiological findings and a history of weight loss of 5 kg in 2 months, patient was referred to us with suspicion of pancreatic mass. Current admission baseline investigations were normal. CA 19-9 levels were 6.23 U/ml. Dynamic three phase CT scan of abdomen showed diffuse smooth circumferential gall bladder wall thickening without any fat stranding and preserved pericholecystic fluid planes suggestive of chronic cholecystitis. There was a hypodensity along the body of pancreas measuring 11mm in size. MRCP was done which also showed a small pancreatic cyst. After thorough discussion, a presumptive diagnosis of walled off necrosis of páncreas was made that has now regressed. Patient was assured and follow up was advised to monitor the cystic lesión. Conclusion Infected pancreatic necrosis may be present and can be confused with pancreatic malignancy in an early stage of development. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important.