MULTIMODAL STRATEGY IN DUODENUM-PRESERVING PANCREATIC HEAD RESECTION FOR AN INFLAMMATORY PANCREATIC HEAD TUMOR omirasabdulbasit@gmail.com

 

MULTIMODAL STRATEGY IN DUODENUM-PRESERVING PANCREATIC HEAD RESECTION FOR AN INFLAMMATORY PANCREATIC HEAD TUMOR

5

Philippines

Oral or Poster

Chronic biliary pancreatitis rarely present as pancreatic head mass as a complication in 6% in one study of cases on imaging resembling malignancy. This poses a particular diagnostic dilemma, often leading to unnecessary extensive surgery. Integration of advanced intraoperative techniques such as ICG fluorescence imaging and ultrasound, is essential to improve surgical precision and patient outcomes.

Rare case of chronic pancreatitis presenting as a pancreatic head mass in a patient with symptomatic gallstones and no history of alcohol use. Preoperative imaging raised a suspicion for pancreatic head malignancy due to enhancing pancreatic head mass with peripancreatic (head) lymphadenopathy and main pancreatic duct stricture.

During surgery, a solid 4 x 3 cm pancreatic head mass is seen adjacent to a 3-cm cyst at the level of pancreatic neck with dilated main pancreatic duct and nondilated distal common bile duct on intraoperative ultrasound. Cholecystectomy was done followed by ICG fluorescence-guided resection of the pancreatic head preserving the duodenum and a roux-en-y pancreaticojejunostomy. Integrity of the distal bile duct and vascularity of the duodenum were also examined and confirmed by ICG fluorescence. Frozen section biopsy along with fine needle aspiration of the pancreatic mass revealed a pseudocyst with chronic inflammation and acute on chronic pancreatitis with no identified malignant cells.

This case illustrates the approach to diagnostic and therapeutic dilemma posed by tumor-like inflammatory lesion in the pancreatic head and indispensable use of intraoperative ICG- fluorescence guided ultrasound, and frozen section biopsy with fine needle aspiration that helped managed the case.