24/M C/o. Jaundice Weight loss

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• 24/MC/o. JaundiceWeight loss
• - 3 weeks
• O/e. Jaundiced
• Abdomen - Soft
• -No mass

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INVESTIGATIONS ?
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• S. Bilirubin Total - 9 mg /dl
• Direct - 4.3 mg/dl
• SGOT - 128 IU/L
• SGPT - 250 IU/L
• SAP - 174 IU/L
• S.Protein - 7.6 gm/dl
• S.Albumin - 4.2 gm/dl
• Anti HAV Ab - -Ve
• HBsAg - - -Ve
• Anti HCV Ab - -Ve

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NEXT INVESTIGATION ?
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• USG-5/2002
• IHBR dilatation, distended GB, dilated CBD,
  dilated pancreatic duct. Bulky pancreatic head.

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NEXT INVESTIGATION ?
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WHAT TO DO ?
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• ERCP stenting done (May 2002).
• Re stenting done in 4 days, because of
• block.

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Patient Developed on off abdominal pain
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CT Abdomen Done
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Patient developed cholangitis on treatment with
higher antibiotics
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What specific investigation needed to diagnose
the nature of the pancreatic head mass ?
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• Endoscopic ultrasound FNAC using
• Endosono.
• Focal lesion in the pancreatic 2.6x2 cm
• Dilated PD 7.5mm
• Cytology Ve for malignancy (Aug 2002)

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• Recurrent cholangitis
• ERCP Re stenting done (Sep 2002).
• Followed by CT abdomen.

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• Recurrent cholangitis
• What to do ?

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• Emergency Surgery- ( Dec 2002 )
• CDD
• Trucut Biopsy of pancreatic mass

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• Biopsy Atypical cells suspicious of
• carcinoma, possibly of
  neuroendocrine differentiation

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What shall we do now ?
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• CHEMOTHERAPY

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• Post chemotherapy
• CT abdomen taken

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• What shall we do now ?

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• WHIPPLES RESECTION DONE

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• 6 months later
• C/O Abd. Distension
• USG CT abdomen
• S/O huge pseudocyst of pancreas

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What shall we do now ?
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• PROCEDURE
• CYSTOGASTROSTOMY DONE