Identification of intraductal papillary mucinous neoplasm by esophagogastroduodenoscopy.

Some reports have described identification of intraductal papillary mucinous neoplasm (IPMN) penetrating to the stomach by esophagogastroduodenoscopy (EGD) [1–4]. However, it seems that detecting an IPMN from within a postoperative pancreatogastric fistula is very rare. A 71-year-old man presented with slight fever. Hehad ahistoryof acutepancreatitis and underwent cystogastrostomy for pancreatic pseudocyst at another institution 8 years earlier. IPMN had not been detected at that time. A detailed examination was carried out, including computed tomography (CT), which revealed a large cystic tumorof thepancreaticheadaccompanied by a pancreatogastric fistula (●" Fig.1). Dilatation of the main pancreatic duct was not evident on magnetic resonance cholangiopancreatography (●" Fig.2). EGD also showed a fistula on the posterior side of the antrum (●" Fig.3). On passing the scope through the fistula a protruding papillary tumor covered with mucus was noted (●" Fig.4). Biopsy samples were obtained and histological examination revealed high-grade tubular adenoma. Pancreatoduodenectomy was subsequently carried out and the patient was diagnosed as having branch-type IPMN containing foci of well-differentiated tubular adenocarcinoma (●" Fig.5). There was no evidence of local invasion or metastasis.