Acute recurrent pancreatitis.
Abdominal CT, post cholecystectomy, pancreatic duct 1.3 cm with a 7 x 2.4 cm cystic lesion in the tail of the pancreas with multiple pancreatic calcification. A 3.4 cm head of the pancreas cystic lesion, soft tissue in the small bowel.
History of colectomy for multiple colon polyps in 1976 and desmoid tumor resection in 1977.
EGD revealed a normal GE junction at 45 cm, innumerable gastric polyps measuring 3-4 mm, excisional biopsy performed x3. The second and third part of the duodenum revealed 8 flat duodenal polyps measuring between 8 mm to 60 mm. The largest polyp was seen distal to the ampulla on the lateral duodenal wall encompassing the hemicircumference. Multiple biopsies were obtained. The ampulla had the classical fish-mouth appearance.
EUS revealed a 6.1 x 4.9 cm dilated heterogeneous cystic structure in the body of the pancreas. FNA with a 19-gauge needle was performed x1 with aspiration of 3 cc of thick mucoid aspirate. The aspirate was sent for CEA, amylase CA 19-9 and the cyst wall for cytology. The patient received 500 mg of Levofloxacin.
The rest of the pancreatic duct appeared markedly dilated to 1.5 cm with minimal diminution to the tail of the pancreas. The head of the pancreas is also replaced by a 2.8 x 2.8 cm heterogeneous multi-cystic lesion. No distinct mural nodules. There were multiple parenchymal calcifications within the cystic collection in the region of the tail of the pancreas. The common bile duct measured 12 mm with no filling defect. The gallbladder is surgical absent. No peripancreatic adenopathy.
EGD with biopsy.
Linear endoscopic ultrasound with fine-needle aspiration.