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Pancreatic adenocarcinoma in a patient with situs inversus: a case report of this rare coincidence.

Sceusi EL, Wray CJ - World J Surg Oncol (2009)

Bottom Line: SI is a rare condition with concurrent pancreatic cancer being even rarer.Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken.Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA. eric.l.sceusi@uth.tmc.edu

ABSTRACT

Background: Situs inversus (SI) is a relatively rare occurrence in patients with pancreatic adenocarcinoma. Pancreatic resection in these patients has rarely been described. CT scan imaging is a principle modality for detecting pancreatic cancer and its use in SI patients is seldom reported.

Case presentation: We report a 48 year old woman with SI who, despite normal CT scan 8 months earlier, presented with obstructive jaundice and a pancreatic head mass requiring a pancreaticoduodenectomy. The surgical pathology report demonstrated pancreatic adenocarcinoma.

Conclusion: SI is a rare condition with concurrent pancreatic cancer being even rarer. Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken. Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

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Related in: MedlinePlus

Pre-diagnosis CT scan. Consecutive CT scan slices demonstrate SI and mild atrophy of the pancreatic head but no mass present 8 months prior to her diagnosis of pancreatic cancer. The CT scan was obtained to evaluate abdominal pain.
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Figure 2: Pre-diagnosis CT scan. Consecutive CT scan slices demonstrate SI and mild atrophy of the pancreatic head but no mass present 8 months prior to her diagnosis of pancreatic cancer. The CT scan was obtained to evaluate abdominal pain.

Mentions: A 48 year old Hispanic female presented to the emergency room with vague abdominal pain and new onset jaundice. Her stated past medical history was significant for diabetes mellitus, hypertension and asthma. Upon physical examination she was alert, afebrile and displayed significant jaundice. Abdominal examination revealed epigastric pain and a left upper quadrant mass. An ultrasound of the abdomen was performed to evaluate for gallbladder pathology, cholelithiasis and/or biliary tract dilation. Upon sonographic evaluation, it was noted that her intra-abdominal organs were not located in the normal anatomic position, including her liver in the left upper quadrant. A chest radiograph also revealed dextrocardia and the diagnosis of situs inversus (SI) was confirmed. Mild gallbladder wall thickening was noted as well as significant extrahepatic biliary duct dilation. Due to the level of jaundice and presumed biliary obstruction an ERCP was attempted, but was unsuccessful due to difficulty with cannulation of the inverted ampulla of Vater. The ampulla was also noted to be significantly protruding into the lumen of the duodenum, thus prompting a CT scan of abdomen. A 4.2 cm pancreatic head mass was discovered (Figure 1). Upon review of the electronic medical record, the patient had a previous CT scan of the abdomen 8 months earlier for vague abdominal pain which showed mild atrophy but no evidence of a pancreatic mass (Figure 2). Her serum CA19-9 (586 U/mL) was also elevated raising the suspicion for pancreatic cancer.


Pancreatic adenocarcinoma in a patient with situs inversus: a case report of this rare coincidence.

Sceusi EL, Wray CJ - World J Surg Oncol (2009)

Pre-diagnosis CT scan. Consecutive CT scan slices demonstrate SI and mild atrophy of the pancreatic head but no mass present 8 months prior to her diagnosis of pancreatic cancer. The CT scan was obtained to evaluate abdominal pain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803176&req=5

Figure 2: Pre-diagnosis CT scan. Consecutive CT scan slices demonstrate SI and mild atrophy of the pancreatic head but no mass present 8 months prior to her diagnosis of pancreatic cancer. The CT scan was obtained to evaluate abdominal pain.
Mentions: A 48 year old Hispanic female presented to the emergency room with vague abdominal pain and new onset jaundice. Her stated past medical history was significant for diabetes mellitus, hypertension and asthma. Upon physical examination she was alert, afebrile and displayed significant jaundice. Abdominal examination revealed epigastric pain and a left upper quadrant mass. An ultrasound of the abdomen was performed to evaluate for gallbladder pathology, cholelithiasis and/or biliary tract dilation. Upon sonographic evaluation, it was noted that her intra-abdominal organs were not located in the normal anatomic position, including her liver in the left upper quadrant. A chest radiograph also revealed dextrocardia and the diagnosis of situs inversus (SI) was confirmed. Mild gallbladder wall thickening was noted as well as significant extrahepatic biliary duct dilation. Due to the level of jaundice and presumed biliary obstruction an ERCP was attempted, but was unsuccessful due to difficulty with cannulation of the inverted ampulla of Vater. The ampulla was also noted to be significantly protruding into the lumen of the duodenum, thus prompting a CT scan of abdomen. A 4.2 cm pancreatic head mass was discovered (Figure 1). Upon review of the electronic medical record, the patient had a previous CT scan of the abdomen 8 months earlier for vague abdominal pain which showed mild atrophy but no evidence of a pancreatic mass (Figure 2). Her serum CA19-9 (586 U/mL) was also elevated raising the suspicion for pancreatic cancer.

Bottom Line: SI is a rare condition with concurrent pancreatic cancer being even rarer.Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken.Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA. eric.l.sceusi@uth.tmc.edu

ABSTRACT

Background: Situs inversus (SI) is a relatively rare occurrence in patients with pancreatic adenocarcinoma. Pancreatic resection in these patients has rarely been described. CT scan imaging is a principle modality for detecting pancreatic cancer and its use in SI patients is seldom reported.

Case presentation: We report a 48 year old woman with SI who, despite normal CT scan 8 months earlier, presented with obstructive jaundice and a pancreatic head mass requiring a pancreaticoduodenectomy. The surgical pathology report demonstrated pancreatic adenocarcinoma.

Conclusion: SI is a rare condition with concurrent pancreatic cancer being even rarer. Despite the rarity, pancreaticoduodenectomy in these patients for resectable lesions is safe as long as special consideration to the anatomy is taken. Additionally, radiographic imaging has significantly improved detection of early pancreatic cancer; however, there continues to be a need for improved detection of small neoplasms.

Show MeSH
Related in: MedlinePlus