Michael J. Abadier, DO1, Andrew E. Abadier, BS2, Wahid J. Abadier, MD3
1Kent Hospital/Brown University, West Warwick, RI; 2University of Pikeville College of Osteopathic Medicine, Knoxville, TN; 3Fort Loudoun Medical Center, Knoxville, TN
Introduction: Acute large bowel obstruction is a rare presentation of pancreatic carcinoma with only 7 cases described in the literature. When located in the head of the pancreas, pancreatic adenocarcinoma commonly presents with abdominal pain, weight loss and jaundice. Pancreatic masses in the body and tail tend to have an insidious onset and may only present with vague abdominal pain. In the case described, a patient presenting with 2 weeks of constipation was found to have a large bowel obstruction in the setting of locally invasive pancreatic adenocarcinoma.
Case Description/Methods: A 64-year-old woman with past medical history of chronic constipation presented to the emergency department with a chief complaint of constipation for 14 days. During these 14 days the patient had developed increasing abdominal distension as well as nausea, vomiting and abdominal pain. Vital signs were unremarkable except for a heart rate of 132. Physical examination was significant for an uncomfortable appearing woman with a diffusely tender and distended abdomen. Laboratory studies showed a leukocytosis of 16.2/uL. CT scan of the abdomen revealed findings suggestive of a primary colon carcinoma of the splenic flexure with upstream colonic obstruction and likely invasion of the pancreatic tail and spleen. General surgery and Gastroenterology were consulted who recommended colonoscopy for evaluation of the presumed mass at the splenic flexure, however, on the day following admission the patient’s clinical status deteriorated. The patient was taken for emergent exploratory laparotomy at which time a markedly distended cecum and right colon were noted. The mass was found to involve the splenic flexure posteriorly as well as the tail of the pancreas and spleen. The patient underwent En Bloc resection of the splenic flexure, spleen and pancreatic tail. Pathology revealed moderately differentiated pancreatic ductal adenocarcinoma and the patient was started on FOLFIRINOX chemotherapy.
Discussion: There have been 3 cases resulting in large bowel obstruction due to local invasion and 4 cases causing obstruction in the setting of metastatic disease. In this case report, we describe an acute obstruction caused by local invasion of pancreatic tail adenocarcinoma. Usual suspects of large bowel obstruction include colorectal carcinoma, volvulus, adhesions, strictures from diverticulitis and hernias. We believe that although rare, once should consider pancreatic carcinoma as part of the differential for large bowel obstruction.
Citation: Michael J. Abadier, DO; Andrew E. Abadier, BS; Wahid J. Abadier, MD. P0084 - PANCREATIC ADENOCARCINOMA PRESENTING AS ACUTE LARGE BOWEL OBSTRUCTION. Program No. P0084. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.