A Case of Adenocarcinoma in Accessory Duct of the Pancreas and its Difficulty in Preoperative Diagnosis

Yuichi Takayama, Yoichiro Kobayashi, Kanji Miyata, Fumihiko Yoneyama, Hidemasa Ohta, Eiji Takeuchi, Koji Komori, Tatsuharu Yamada, Shinya Watanabe and Masanori Uno

Department of Surgery, Japanese Red Cross Nagoya 1st Hospital

We report a case of adenocarcinoma in the accessory duct of the pancreas and its difficulty in preoperative diagnosis. A 69-year-old man admitted for nausea and vomiting was found in endoscopic examination to have stenosis at the descending duodenum with edema and redness of the mucosa. Biopsy showed no malignancy, and physical examination and blood tests were unremarkable. Duodenography showed irregularity in the wall of the duodenal bulb. CT showed a tumorous leision at the head of the pancreas. The common bile duct and main pancreatic duct was normal on MRCP. We conducted a pylorus resecting pancreatoduodenectomy, because intraoperative rapid histopathological examination of the shrinkage at the head of pancreas indicated adenocarcinoma. The tumor was localized between the submucosa of the duodenum and the head of the pancreas. The cut surface of the specimen showed that invasion to the duodenum was greater than to the pancreas. Pathological study showed that the main pancreatic duct was normal, but adenocarcinoma was localized in the accessory pancreatic duct. The Accessory pancreatography with contrast medium in the resected specimen showed stenosis due to adenocarcinoma.

Key words
duodenal stenosis, accessory pancreatic duct

Reprint requests
Yuichi Takayama Department of Surgery, Japanese Red Cross Nagoya 1st Hospital
3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511 JAPAN

Accepted
March 24, 2004

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