Korean J Gastrointest Endosc > Volume 38(4); 2009 > Article
Korean Journal of Gastrointestinal Endoscopy 2009;38(4): 242-245.
다발성 누공과 십이지장 궤양 출혈로 내원한 췌관 내 점액성 유두 종양 1예
연세대학교 원주의과대학 내과학교실, *병리학교실, 영상의학교실
A Case of a Pancreatic Intraductal Papillary Mucinous Neoplasm Forming Multiple Fistulas and Manifesting as Duodenal Ulcer Bleeding
Hearn Kook Kim, M.D., Jae Woo Kim, M.D., Myeong Hun Chae, M.D., Jin Hyung Lee, M.D., Hyun Soo Kim, M.D., Soon Koo Baik, M.D., Mee Yon Cho, M.D.* and Seung Whan Cha, M.D.
Departments of Internal Medicine, *Pathology and Radiology, Yonsei University Wonju College of Medicine, Wonju, Korea
An intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an uncommon tumor characterized by the production of mucin in the pancreatic duct that occasionally involves the formation of fistulas with surrounding organs, including the stomach, duodenum and common bile duct. The mechanism underlying the formation of such fistulas is direct invasion by a tumor or a combination of high pressure in the main pancreatic duct and inflammatory stimulation. A 73-year-old man was referred to our hospital due to the presence of a gastric ulcer detected on screening gastroscopy. Endoscopic findings showed the presence of a whitish thick mucin coated ulcerative lesion that appeared as a perforation or fistula opening. Abdominal computed tomography and magnetic resonance cholangiopancreatography demonstrated the presence of an IPMN of the pancreas and multiple fistula formation with the neighboring organs. An endoscopic biopsy was carried out to obtain pancreatic tumor tissue through the pancreatogastric fistula and the mass was confirmed as a mucinous adenocarcinoma. To the best of our knowledge, this is the first case of an IPMN associated with a pancreatojejunal fistula and duodenal ulcer bleeding due to fistula formation. (Korean J Gastrointest Endosc 2009;38:242-246)
Key Words: Intraductal papillary mucinous neoplasm, Fistula, Bleeding
주요어: 췌관 내 점액성 유두 종양, 누공, 출혈
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