Pancreatic Duct Dilatation Following Acute Pancreatitis: An Early Clue to Pancreatic Cancer

Pancreatic cancer may initially manifest as acute pancreatitis, and non-mass-forming neoplasms may be detectable through indirect findings, such as main pancreatic duct (MPD) dilatation or an abrupt ductal cutoff.A 67-year-old woman with no significant medical history, alcohol consumption, or smoking presented with acute pancreatitis.Computed tomography (CT) demonstrated acute pancreatitis and an abrupt MPD cutoff, whereas magnetic resonance imaging revealed no mass or ductal stricture.Two months later, pancreatitis recurred.Repeat CT showed a cutoff at the pancreatic neck, while endoscopic ultrasonography (EUS) revealed no mass.Endoscopic retrograde pancreatography demonstrated MPD tortuosity without definite stricture, and a pancreatic duct stent was placed.Subsequent imaging showed no mass or persistent stricture.Approximately 19 months after the initial episode, surveillance CT revealed an uncinate process mass, and EUS-guided fine-needle biopsy demonstrated poorly differentiated carcinoma.Pylorus-preserving pancreaticoduodenectomy revealed a 2.5-cm carcinoma with metastases in two regional lymph nodes (pT2N1).After 12 cycles of adjuvant FOLFIRINOX, recurrence involving the superior mesenteric vein was identified.Recurrent acute pancreatitis with an unexplained MPD cutoff warrants continued attention despite repeated negative multimodal examinations.However, temporal association alone does not prove that invasive cancer was initially present; structured surveillance and assessment of anatomical concordance remain essential.