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Division of Gastroenterology, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
Division of Gastroenterology, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
Division of Gastroenterology, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
A 69-year-old man presented with an incidental finding of a diffusely dilatated pancreatic
duct to 18 mm on CT performed for evaluation of emphysema. Magnetic resonance imaging
showed an additional 12-mm mural nodule in a side branch duct in the tail of the pancreas.
A multidisciplinary tumor board agreed during discussion that performing a segmental
distal pancreatectomy to remove the nodule might not be of benefit if there were high-risk
lesions in the proximal pancreatic duct, given the diffusely dilatated pancreatic
duct without obvious lesions of the proximal main duct. Therefore, pancreatoscopy
was performed to rule out high-risk lesions in the head or neck of the pancreatic
duct. Digital pancreatoscopy revealed a dilated head and neck of the pancreatic duct,
but the duct was otherwise normal (Fig. 1A; Video 1, available online at www.giejournal.org). Mucin was seen in the neck of the pancreatic duct, and this explained the diffuse
duct dilatation (Fig. 1B). There was a discrete transition in the body of the pancreatic duct to a duct lined
with papillary fronds consistent with intraductal papillary mucinous neoplasm (Fig. 1C). Given the pancreatoscopy findings, the patient underwent segmental body and tail
pancreatectomy. Digital pancreatoscopy can define anatomy that can aid in surgical
management of main duct intraductal papillary mucinous neoplasm.
Figure 1Pancreatoscopy images showing A, normal epithelium in a dilated head of pancreas duct; B, a dilated neck of pancreas duct with mucin; and C, body of the pancreas duct with papillary fronds consistent with intraductal papillary
mucinous neoplasm.
