MRCP in a 62-year-old man with recurrent acute pancreatitis demonstrates diffuse dilatation of the main pancreatic duct to 12 mm with a mural nodule at its head. Fine-needle aspiration cytology shows mucinous epithelium. The most appropriate treatment is:
- A Surveillance MRCP every 6 months
- B Pancreaticoduodenectomy ✓
- C Total pancreatectomy
- D Distal pancreatectomy with splenectomy
Correct answer: B. Pancreaticoduodenectomy
Explanation
Main duct intraductal papillary mucinous neoplasm carries a high risk of invasive carcinoma, roughly 60 to 70 percent in resected series, so all fit patients with main duct involvement should undergo resection. A head lesion dictates pancreaticoduodenectomy. Branch duct IPMNs below 3 cm without nodules or ductal change can be surveilled, which makes surveillance wrong here given the dilated duct and mural nodule. Distal pancreatectomy suits body or tail lesions, and total pancreatectomy is reserved for selected multifocal or extensive disease.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.