Enormously dilated pancreatic duct

A diabetic patient presented with 10 kg weight loss and slightly elevated C reactive protein without diarrhoea, abdominal pain, fever or leucocytosis. Serum lipase, transaminases, bilirubin, carcinoembryonic antigen and CA19-9 were normal. Ultrasound showed prominent perihilar bile ducts and a cystic mass of the pancreas (60×57 mm) with echogenic internal structures, which was identified as the main pancreatic duct on endoscopic ultrasound (EUS), without enlarged peripancreatic lymph nodes (figure 1A,B). At endoscopic retrograde cholangio-pancreatography (ERCP), the compressed common bile duct was secured by a plastic stent. Cannulation of the pancreatic duct resulted in massive putrid secretion and confirmed an enormously dilated main pancreatic duct over its full length (figure 1C,D). Figure 1 (A) …