P1488 - A Rare Case: Pancreatic GOO

Joshua Diaz, MD¹, Akil Olliverrie, MBBS¹, Sara Samad, DO², Muhammad Abdulla, MD^1
1South Brooklyn Health, Brooklyn, NY; ²NYC Health + Hospitals, South Brooklyn Health, Brooklyn, NY

Introduction: Pancreatic cancer is a unique challenge for physicians. In the U.S it is the 14th most common cancer and 7th most fatal with a 2-9% 5 year survival. This is due to lack of a screening protocols and aggressive nature of the malignancy that is asymptomatic until local invasion of tissue. Symptoms vary based on location and 65% of masses arise in the head of the pancreas and most commonly cause biliary obstruction with jaundice, scleral icterus, abdominal pain, nausea and weight loss. This unusual presentation of a pancreatic cancer highlights different symptoms that could spark the inclusion of this diagnosis in our differential.

Case Description/Methods: A 70 year old woman with gastroesophageal reflux disease and diabetes presented with post-prandial nausea and emesis, heart burn, bloating and weight loss. Physical examination was unremarkable and negative for jaundice, scleral icterus, abdominal or back pain. Blood tests were unremarkable. CT abdomen showed a mass obstructing the proximal duodenum, dilated stomach and esophagus. Upper endoscopy revealed an obstructive extra-luminal duodenal mass that was biopsied and a stricture that could not be traversed. Ca 19-9 was 123 and CEA was 21.6. Whipple procedure was attempted but aborted due to invasion of the hepatic artery and gastrojejunostomy with cholecystectomy with was performed instead. The histopathology report of the biopsied tissue showed invasive pancreatic adenocarcinoma.

Discussion: Pancreatic cancer is an aggressive and fatal malignancy with smoking, chronic pancreatitis, increased age, male sex and African American ethnicity as risk factors. Only those with 2 or more 1st degree relatives with pancreatic cancer are screened, but regardless is often diagnosed in late stages with 85% being non-resectable. Common symptoms are weight loss, abdominal pain, thoracic back pain, jaundice, scleral icterus and nausea. Disease presentation varies based on its location. The Gold standard for diagnosis of cancer is histopathological analysis of tissue. Endoscopic Ultrasound, CT and MRI best assess stage and vascular involvement. The only cure of pancreatic cancer is surgical resection. This case highlights an unusual presentation of invasive and annular pancreatic cancer of the duodenum causing gastric outlet obstruction as opposed to obstructive jaundice. Patients in higher risk demographic groups with risk factors presenting with gastric outlet obstruction should have further imaging to evaluate pancreatic cancer as a possible etiology.



Disclosures:


Joshua Diaz, MD¹, Akil Olliverrie, MBBS¹, Sara Samad, DO², Muhammad Abdulla, MD¹. P1488 - A Rare Case: Pancreatic GOO, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.