3032 Acute Presentation of Undiagnosed Pancreatic Cancer With Fatal Prognosis

Abstract

INTRODUCTION: Most common presentation of pancreatic cancer are abdominal pain, weight loss and jaundice. However, these symptoms manifest mostly with advance disease and are non-specific making the early diagnosis difficult. Consequences of missing diagnosis can be fatal leading to metastatic disease and decease life expectancy. We came across similar case with obstructive jaundice and had pancreatic mass with life span of 2 months after diagnosis. CASE DESCRIPTION/METHODS: 69 years old male was admitted for a mechanical fall. His past medical history included CAD, chronic pancreatitis, and diabetes mellitus. He reported 6 days history of pale stools and dark urine which resolved 2 days prior to presentation but had some associated chronic abdominal pain with 50 lb unexplained weight loss over past 6 months. On examination, he was found to have scleral icterus and jaundiced skin. On blood work, he was noted to have AST 242, ALT 477, ALP 508, and bilirubin 13.0 and direct bilirubin of 10.4. All values were normal one month prior to current admission. Abdominal ultrasound showed dilated CBD to 15 mm, intrahepatic ducts and a distended gallbladder without stones. He underwent MRCP and was found to have dilated CBD with 13 mm diameter, intrahepatic biliary ducts, and distended gall bladder with abrupt cut off of the distal CBD. There is also dilatation of pancreatic duct measuring up to 11 mm with a cut off of the proximal pancreatic duct by a large amorphous mass. ERCP was done, but wire passage in CBD was restricted by possible tumor which lead to limitations like lack of biopsy and stent placement. PET CT showed fullness in pancreatic head with increased FDG uptake. He underwent cholecysto-gastrostomy for internal biliary decompression and was noted to have distended gallbladder, and fibrotic pancreas with no pancreatic mass. Bilirubin dropped the surgery. Patient refused invasive procedures afterwards for tissue diagnosis of cancer. He died 2 months after surgery. DISCUSSION: Pancreatic cancer is fourth leading cause of cancer related deaths in United States. Incidence increases after the age of 45 with more male to female ratio 1.3:1. USPSTF found no evidence of improved mortality with screening in asymptomatic patients. Surgical resection is only curative with less role among patients with late presentation emphasizing the importance of early diagnosis. Physician should have high suspicion among patients with risk factors to avoid deadly complications.