A 66-yearold female presented to her gastroenterologist with jaundice, weight loss, upper right quadrant abdominal pain, and diarrhea. She continued to carry out normal activity but reported requiring rest on most days.
CA19-9: 2296 U/ml
Abdominal CT scan showed an expansive lesion measuring 39 × 26 mm between the pancreas and inferior vena cava, below the portal vein. There was enlarged para-aortic lymph node and stenosis of the common bile duct.
Endoscopic retrograde cholangiopancreatography was performed and the patient was referred for surgery.
Explorative laparotomy showed the mass to be inoperable because of local vascular infiltration and liver metastases.