Case of mixed - type intraductal papillary - mucinous neoplasm of pancreas highlighting the need of multidisciplinary approach

Abstract

Mixed-Type Intraductal Papillary-Mucinous Neoplasms (MT– IPMNs) of pancreas are rare mucin producing papillary growths involving the Main Pancreatic Duct (MPD) and Branch Ducts (BD). Among other subtypes, MT-IPMNs are the most challenging in determining the ideal therapeutic strategy. A 56-year-old female presenting with severe acute epigastric abdominal pain due to acute on chronic pancreatitis was diagnosed with a cystic lesion in the pancreatic head by Contrast Enhanced Computed Tomography (CECT) imaging. Further imaging, interventions or follow-up were not offered. The patient presented four years later with a similar presentation to be subjected to pancreaticoduodenectomy following diagnosis of IPMN through Magnetic Resonance Cholangiopancreatogram (MRCP) and Endoscopic Ultrasound (EUS) imaging. The report highlights the necessity for heightened consideration of the role of MRCP as a determinant of the management strategy and the awareness of indications for surgery in MT-IPMNs in the Sri Lankan surgical setting.