Pancreatic mass with an unusual pathology: a case report

Abstract

Intra-abdominal abscesses formation in patients with no preceding symptoms is rare. Infection of the pancreas occurs in 5-9% of patients with acute pancreatitis, more commonly as a complication of necrotising or severe pancreatitis. We have reported a case of a 64-year-old almost entirely asymptomatic man who underwent a Whipple's procedure following extensive investigation of a pancreatic mass. The pathology and histology showed no evidence of malignancy, and instead a true pancreatic abscess, centred around an impacted cholesterol calculus in the distal CBD. Of suspicious pancreatic masses that are resected, chronic choledocholithiasis is the aetiology in less than 5% of nonmalignant or "false positives." This report describes such a case.

Figure 1

ERCP films show the proximal common bile duct stricture and dilated distal biliary tree.

Figure 2

CT with contrast (arterial phase) showing the mass at the head of the pancreas (PM) and dilated common bile duct (dCBD).

Figure 3

Pancreaticoduodenectomy resection specimen, showing sectioning (in the plane of the black dotted line) of the second part of the duodenum (D), the common bile duct (CBD), the site of the previously impacted gall stone calculus (IGS), the biliary stricture (blue dotted line) and pancreatic abscess cavity (PA).