Abstract
A 47 year-old female presented with a reducible bulging mass at umbilicus. Physical examination showed no jaundice, no abdominal pain, but the abdomen was distended due to obesity. Under the impression of umbilical hernia, herniorrhaphy was arranged. However, a large cystic mass was observed through the fascia defect during operation. Pancreatic cystic tumor was suspected and CT was arranged after herniorrhaphy. CT demonstrated a giant (28x26cm) lobulated cystic mass was found mainly in central abdomen with internal septa. Distal pancreatectomy with splenectomy was performed and pathology showed mucinous cystic neoplasm (MCN) with low-to intermediate grade dysplasia. The post-operative course was uneventful and her body weight decreased from 90 to 75 kilograms. Pancreatic tumor usually presented with symptoms such as abdominal pain, back pain, or jaundice. Umbilical hernia is an unusual presentation of pancreatic tumor, and it might be neglected in obese patient. Sophisticated investigation of the etiology of increased intraabdominal pressure and careful inspection during herniorrhaphy may help us not to lose the diagnosis of pancreatic tumor in such an unusual presentation.
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