SHM Converge Scientific Abstract ePoster Gallery-Ampullary Neuroendocrine Neoplasm Mimicking Biliary Obstruction and Pancreatitis: A Case Report

Pdf Summary

This case report describes a rare cause of acute pancreatitis and biliary obstruction due to an ampullary neuroendocrine tumor (NET). A 78-year-old woman with hypertension and a history of treated intracranial aneurysm presented after syncope with epigastric pain. Labs showed markedly elevated lipase and transaminases, along with hypokalemia, but no clear evidence of infection or common pancreatitis triggers such as alcohol use, hypertriglyceridemia, or prior pancreatic disease.<br /><br />Initial imaging with CT showed no pancreatic inflammation, while ultrasound demonstrated mild hepatomegaly, steatosis, and a dilated common bile duct, suggesting biliary obstruction. Because MRCP was delayed due to concern related to her aneurysm history, the patient underwent ERCP. This revealed an ulcerated ampullary mass obstructing both the bile and pancreatic ducts. A biliary stent was placed for decompression, and biopsy confirmed a well-differentiated grade 2 neuroendocrine tumor.<br /><br />The discussion emphasizes that ampullary NETs are rare and can be difficult to detect with routine imaging, which may only show secondary signs such as ductal dilation. ERCP was crucial in this case because it both established the diagnosis and provided treatment. The report highlights the importance of considering unusual malignant causes when evaluating acute pancreatitis, especially in older patients with atypical presentations.

Asset Subtitle

Graciela M. Luna

Meta Tag

Author List Amanda Rigdon, Camila Villacreses, Cassidy Colwell, Graciela M. Luna, Omar Zuhdi

Category Clinical Vignettes

Concept Ampullary Neuroendocrine Tumor

Concept Endoscopic Retrograde Cholangiopancreatography

Concept Biliary Obstruction

Concept Acute Pancreatitis

Concept Lipase

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health Medical Center

Presenting Author Graciela M. Luna

Track Adult

Keywords

acute pancreatitis

biliary obstruction

ampullary neuroendocrine tumor

ERCP

common bile duct dilation

biliary stent

ampullary mass

well-differentiated NET

pancreatic duct obstruction

case report

Ampullary Neuroendocrine Tumor

Endoscopic Retrograde Cholangiopancreatography

Biliary Obstruction

Acute Pancreatitis

Lipase