Total pancreatectomy for cholangiocarcinoma of the distal common bile duct associated with lipomatous pseudohypertrophy of pancreas

Abstract

Introduction: Fatty replacement of the exocrine pancreas also known as lipomatosis, adipose atrophy or lipomatous pseudohypertrophy is a well recognize benign condition. This fatty infiltration can occur either focally or involving the whole pancreas. Case Report: We report a rare case of lipomatous pseudohypertrophy of the pancreas associated with cholangiocarcinoma of the distal common bile duct (CBD). A 51-yearold female presented to our unit with a history of obstructive jaundice. Radiological imaging suggested a cholangiocarcinoma of the distal CBD with pancreatic lipomatosis, without any clinical evidence of exocrine or endocrine dysfunction. She underwent a radical bile duct excision and a total pancreatectomy. Histology revealed lipomatosis of the pancreatic body and tail with sparse pancreatic tissue adjacent to the tumor. After an uneventful recovery, she was started on lifelong insulin and pancreatic enzyme supplements. Even though pathogenesis of pancreatic lipomatosis remains controversial, it is most likely due to obstruction of the pancreatic duct in this presentation. Conclusion: It is import to undertake total pancreatectomy for this dual presentation with specialized endocrinological support in the stormy postoperative period.