An 89-year-old woman with a history of arterial hypertension, type 2 diabetes mellitus, atrial fibrillation, and COPD was admitted due to sudden onset of pruritus.
He did not report anorexia or abdominal pain.
Physical examination revealed painless indurated area in the epigastrium and the rest of the examination was irrelevant.
Blood tests showed the following parameters: total bilirubin 12.88 mg/dl (range, 0.1-1), direct bilirubin 9.92 mg/dl (range, 0.01-0.25), normal ALT 5-4435 U/dl (range, 1.946
An emergency ultrasound was performed, revealing a vesicular mass located in the pancreatic head, predominantly multi-layered intrahepatic bile duct with lobulated margins, with dilatation of the main bile duct.
A computed tomography was performed, which showed a multicystic mass in the head of the pancreas with septa and «sun-layered» calcifications that caused pancreatic cystadenoma, compatible with Wirsadenoma.
He also had a very distended gallbladder and marked dilatation of the intrahepatic bile duct and bile duct.
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Given the patient's age and personal history, she was not considered eligible for surgical intervention and underwent endoscopic retrograde cholangiopancreatography (ERCP).
When performing ERCP, some difficulty was observed in passing the endemic through the superior duodenal knee, probably related to compression by the primary pancreatic lesion.
Cholangiography showed a large dilation of the proximal bile duct with distal stenosis of approximately 3-4 cm in length.
A self-expanding metallic biliary stent Wallstent type was placed (Boston Scientific, Natick, MA, USA) of 8 cm in length and 1 cm in caliber without incidents, with subsequent drainage.
The patient presented a progressive mucocutaneous depigmentation with decreased bilirubin levels.
Finally, the patient was discharged asymptomatic.
