ERCP导管内乳头状黏液性肿瘤

                               
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A 86 year old man was investigated for haematuria 18 months ago. An abdominal CT scan did not show any renal abnormalities but there was “incidental” massive dilatation of the entire pancreatic duct. He was thought to have main duct Intraductal Papillary Mucinous Neoplasia (MD-IPMN) and, after MDT discussion, was managed conservatively. He now presents with jaundice, 2 stone weight loss and probable cholangitis. Bilirubin 110 umol/L, Alk phosp 990, ALT 85, WBC 10. An MRCP shows widespread dilatation of both the pancreatic duct and the biliary tree. See video for subsequent ERCP.