Challenging the limits in pancreatic surgery: A case report

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Pancreatic surgery is complex due to anatomical challenges.
• Accurate diagnosis of pancreatic masses is crucial but often difficult.
• Autoimmune pancreatitis can mimic pancreatic cancer, complicating diagnosis and treatment.

Purpose of the Study:

• To present a unique case of misdiagnosed pancreatic head mass.
• To illustrate the diagnostic and surgical challenges in complex pancreatic conditions.
• To emphasize the importance of histopathological analysis in differentiating pancreatic pathologies.

Main Methods:

• A young woman presented with abdominal pain and a pancreatic head mass.
• Initial laparotomy elsewhere deemed the mass unresectable; biopsies were negative for malignancy.
• CT revealed stent dislocation into the stomach; surgical management included mesenterico-caval shunt, stent removal via gastrotomy, and pancreaticoduodenectomy.

Main Results:

• Histopathology confirmed granulocytic epithelial lesions (GELs), indicative of type-2 autoimmune pancreatitis.
• No evidence of malignancy was found.
• The patient experienced an uneventful postoperative recovery and symptom resolution.

Conclusions:

• This case underscores the diagnostic complexity of pancreatic lesions and the differential diagnosis between pancreatitis and cancer.
• It highlights the surgical challenges posed by uncommon pancreatic conditions requiring intricate approaches.
• Accurate histopathological evaluation is vital for appropriate patient management.