Pancreatic head adenocarcinoma with choledocoduodenal fistula

Case contributed by Dr Ahmed Abdrabou


Recurrent abdominal pain and vomiting of 1 month duration

Patient Data

Age: 60 years
Gender: Male

A large irregular pancreatic head mass with extensive necrosis is noted. It is inseperable from the measenteric vessels, partial thrombosis of the portal vein, dilated pancreatic duct, invades the 2nd part of the duodenum and associated with massive pneumobilia. There is also contrast filling of the CHD and right posterior hepatic duct suggesting choledoco-duodenal fistula formation. Multiple hypodense hepatic focal lesions as a metastatic deposits.

Black arrow refers to the invasion of the 2nd part of the duodenum by the pancreatic mass.

Red and blue arrows refer to the contrast filling the right posterior hepatic duct and CHD respectively.

Case Discussion

Pancreatic duct adenocarcinoma was found on biopsy. The tumor invades the 2nd part of the duodenum and CBD forming a choledocoduodenal fistua that results in massive pneumobilia and presence of oral contrast within the dilated bile ducts. It was staged as T3N0M1

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