The 70-year-old woman fought this battle with the help of the expert team of doctors. Amidst the Pandemic, the woman visited famed Gastrointestinal Surgeon, Dr. Suddhasattwa Sen, for the first time with severe abdomen pain and was admitted accordingly with the suspicion of acute pancreatitis.
Though her blood amylase lipase levels were normal, she was diagnosed with a large solid cystic mass in the pancreas body tail region. Meanwhile, her CT scan and USG report suggested pseudocyst or walled-off pancreatic necrosis.
Speaking on the case Dr. Suddhasattwa Sen speaking to News Sense said, “I was not convinced, so sent for Endo USG and all tumor marker and fluid studies for mucin ca199 cea amylase ca 15-3 and cell culture and study. All tumor markers in fluid and blood were high in thousands and few linear calcifications with fuzzy septa in SOL (tumor) Now comes the dilemma between cystic pancreatic cancer ( rare type) vs pancreatic necrosis. EUS suggested walled-off pancreatic necrosis. So all radiological examination suggested benign necrosis. I was still dubious considering high tumor markers. Did another triphasic CT scan which suggested a mixed picture of cancer along with necrosis. The Splenic artery and vein were involved by tumor and replaced by multiple collateral varices ( sinistral hypertension with thin-walled multiple abnormal blood vessels all around which increased chances of severe bleed). We explored under high risks situations as the patient also has associated problems like Hypertension, Diabetes, Hypothyroid, COPD“.
He further says, “We found a mixed picture inside. It was a cystic pancreatic cancer that had also given rise to pancreatitis and hence necrosis. So it was a bad double combination. Dissecting involved blood vessels was too difficult and tricky but we could succeed. Finally after dividing the pancreas with splenic vein just at the level of Portal vein formation ( visible on the picture behind pancreas proximal transaction staple line ). We could complete RAMP ( Radical Antegrade modular Pancreatosplenectomy) where the entire body tail pancreas with a tumor with spleen was taken out with all lymphatic and lymph nodes and fibrofatty tissue with the posterior fascia exposing the left kidney and left renal vascular structures after completion of the operation“.
After 2 hours and 10 minutes, the rare and difficult operation was made successful by the team under the leadership of Dr. Suddhasattwa Sen, as he says, “we have done RAMPS before but hardly any with tumor and pancreatic necrosis combined with past pancreatitis especially with all blood vessels involved and severe collateral vessels in all planes. The Patient is stable now“.
Abhishek Jana, son of the Patient, speaking to News Sense, said, “My mother is fine now and recovering. She is able to eat normally now and has no complications. The team of Doctors did the operation on time“.
Whatever the report says, always trust the clinical judgment and do what is right. Else both you and the patient can land up in dubious diagnosis and hence the treatment is a completely different direction with severe connotations. Don’t miss the bus by miles. Be maximum sure before deciding what’s right in such atypical cases.