Endoscopic "string sign".

A 76-year-old female patient was admitted at hospital with diarrhea, weight loss, fatigue and abdominal pain. Her physical examination and laboratory test were normal; however, the radiological images showed an atrophic pancreas with cystic dilatation of the main pancreatic duct. Severe dilatation of the main pancreatic duct was confirmed on EUS, with the presence of round images of mucinous aggregates within (droplets of mucous plug). In view of these findings, we performed a duodenoscopy, which showed mucin extrusion from a patent ampulla (a “fish-mouth” look-like patulous papilla with mucus excretion from the orifice; Image 1), a pathognomonic finding of intraductal papillary mucinous tumor (IPMT) of the main pancreatic duct. We obtained blind biopsies and the histological results confirmed the diagnosis of IPMT. After removing the duodenoscope, a mucus string of about 40 cm in length was adhered to the biopsy channel of the duodenoscope (Image 2). Received September 11th, 2013 – Accepted December 11th, 2013