A 58-year-old man with recurrent acute pancreatitis has MRCP showing diffuse dilatation of the main pancreatic duct to 11 mm with a mural nodule in the head. EUS-guided aspirate shows mucinous epithelium with moderate dysplasia. The most appropriate management is:
- A Surveillance MRCP every 12 months
- B Pancreaticoduodenectomy ✓
- C Total pancreatectomy
- D Endoscopic stenting of the pancreatic duct
Correct answer: B. Pancreaticoduodenectomy
Explanation
Main duct intraductal papillary mucinous neoplasm carries a high rate of invasive carcinoma, and any main duct IPMN is an indication for resection, reinforced here by duct dilatation above 10 mm and a mural nodule. The tumour is centred in the head, so pancreaticoduodenectomy is the operation of choice. Total pancreatectomy is excessive unless disease extends through the whole gland, and surveillance applies only to branch duct lesions without high-risk features.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.