Successful Management of Dilated Intrahepatic and Extrahepatic Ducts in Adenocarcinoma of the Pancreatic Head: A Case Report
A. E. Ben-Chioma
*
Department of Clinical Chemistry, Faculty of Medical Laboratory Science, Rivers State University, Port Harcourt, Nigeria.
I. Elekima
Department of Clinical Chemistry, Faculty of Medical Laboratory Science, Rivers State University, Port Harcourt, Nigeria.
D. O. Onwuli
Department of Clinical Chemistry, Faculty of Medical Laboratory Science, Rivers State University, Port Harcourt, Nigeria.
O. I. Alatise
Department of Surgery, Osun State University Teaching Hospital, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
More than 90% of cases of pancreatic cancer are adenocarcinomas, making them the most prevalent gastrointestinal cancer disease. This cancer develops in the pancreatic duct lining. Adenocarcinoma may also arise from the cells that produce pancreatic enzymes. The features of adenocarcinoma are abdominal pain, diarrhoea, nausea, weight loss and jaundice. A rise in enzymes might cause joint discomfort and skin rashes in certain patients. Pancreatic head adenocarcinoma is a major cause of malignant biliary obstruction and frequently manifests as simultaneous intrahepatic and extrahepatic duct dilatation.
A 76-year-old male presented to the hospital with 3-days diarrhoea. Diagnosis showed tumour head of pancreas, leading to hepatobiliary obstruction, manifesting with pruritis, weight loss and loss of appetite. Initial CT scan, CA markers and other biochemical parameters were very abnormal. The patient initially received endoscopic (ERCP) stent placement and later surgery (Whipple’s procedure) to remove the tumour. Histology showed grade 1A adenocarcinoma and 6-cycle of -12 sessions of chemotherapy was done fortnightly with NAB-paclitaxel and gemcitabine-based drugs. During these therapies, the elevated markers gradually reduced with variations in some biochemical parameters. Later CT scan showed no mass or calcification on the pancreas and no biliary dilatation.
Well differentiated adenocarcinoma of the pancreas can be treated when discovered early as poorly differentiated adenocarcinoma is very aggressive. Multidisciplinary individualized treatment is essential and should be utilized.
Keywords: Adenocarcinoma, intrahepatic bile duct dilatation, extrahepatic bile duct dilatation, chemotherapy, Whipple’s procedure