PANCREATIC HEAD ADENOCARCINOMA IN THE CONTEXT OF PROBABLE CHRONIC PANCREATITIS: A CASE REPORT AND SURGICAL APPROACH

Abstract

Pancreatic adenocarcinoma is a highly lethal neoplasm, often diagnosed in advanced stages. Chronic pancreatitis is a known risk
factor for its development. The classic presentation includes obstructive jaundice, epigastric pain, and weight loss. Case Presentation: We present the case of a 50-year-old male patient with no comorbidities, who presented with a 7-day history of  postprandial epigastric pain, associated with jaundice, choluria, acholia, and a 3 kg weight loss. Physical examination revealed jaundice and epigastric tenderness. Laboratory tests showed an obstructive cholestasis pattern (Total Bilirubin 12.60 mg/dL) with elevated transaminases (AST 209 U/L, ALT 431 U/L) and lipase (309 U/L). Diagnosis and Treatment: Endoscopic ultrasound (EUS)
identified a 20 mm hypoechoic lesion in the pancreatic head. Biopsy confirmed adenocarcinoma. The patient underwent a total
pancreatectomy with splenic preservation, reconstructed with a  choledochojejunostomy and a gastrojejunostomy. Conclusion: This case highlights the importance of diagnostic suspicion for pancreatic cancer in patients with abdominal pain and jaundice, even in the presence of elevated pancreatic enzymes that might suggest pancreatitis. EUS was crucial for the differential diagnosis and histological procurement.