Fenestration for a pancreatic serous cystic neoplasm with obstructive jaundice

Abstract

A 55-year-old woman, presented with jaundice, and a medical examination revealed a cystic tumor in the head of pancreas. She had iatrogenic Cushing's syndrome, because she had taken an antihistamine agent, containing a corticosteroid, for more than 15 years. Contrast enhanced CT showed the multilocular cystic tumor of the head of pancreas. The bile duct, superior mesenteric vein and portal vein were compressed by the tumor, and significant collateral veins were developed in the hepatoduodenal ligament. We diagnosed the tumor as a macrocystic type serous cystic neoplasm. We performed fenestration of the cystic wall and ethanol ablation into the lumen of the residual wall, considering the high surgical risk of the patient. No recurrence of the cystic tumor or obstructive jaundice has been detected 12 months after the operation. Thus, fenestration of the tumor may be an option for treatment of a patient with large and symptomatic macrocystic type serous cystic neoplasm at high surgical risk. © 2014 The Japanese Society of Gastroenterological Surgery.