[Suspected malignant cancer of the pancreas associated with pseudo-invasive duodenal hamartomas in a patient with Peutz-Jeghers syndrome].
A 29-year-old man with a previously known Peutz-Jeghers syndrome (PJS) was admitted for epigastric pain, emesis and weight loss due to both intestinal intussusception causing bowel obstruction and obstructive pancreatitis. The patient had cholestasis with an enlarged common bile duct on imaging. Because duodenal and/or pancreatic cancer was suspected due to weight loss, the pancreatic and bile duct obstruction, and the increased risk of small intestine and pancreatic adenocarcinoma in patients with PSJ, a pancreatoduodenectomy was performed. Pathological examination revealed a duodenal polyp with epithelial misplacement invading the ampulla and compressing the main bile duct. Twenty months after surgery, there was no relapse of symptoms or cholestasis. This is the first case showing a direct role of pseudo-invasive duodenal harmatomas in the development of biliary obstruction and chronic obstructive pancreatitis.
Rautou
Pierre-Emmanuel
PE
Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France.
Hammel
Pascal
P
Couvelard
Anne
A
Rivet
Pierre
P
Aubert
Alain
A
Lévy
Philippe
P
Ruszniewski
Philippe
P
D000328:Adult; D014670:Ampulla of Vater / Q000473:pathology; D001651:Cholestasis, Extrahepatic / Q000209:etiology; D003137:Common Bile Duct Diseases / Q000150:complications; D004378:Duodenal Diseases / Q000150:complications*; D006222:Hamartoma / Q000150:complications*; D006801:Humans; D007417:Intestinal Polyps / Q000150:complications*; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications*; D050500:Pancreatitis, Chronic / Q000209:etiology; D010580:Peutz-Jeghers Syndrome / Q000150:complications*