MRCP in a 58-year-old man with recurrent acute pancreatitis shows diffuse dilatation of the main pancreatic duct measuring 14 mm with a mural nodule in the head. There is no communication with a cystic lesion. Serum CEA and CA 19-9 are unremarkable. What is the most appropriate management?
- A Surveillance imaging every 6 months
- B Surgical resection ✓
- C Endoscopic cystogastrostomy
- D Total pancreatectomy with islet autotransplantation as first choice
Correct answer: B. Surgical resection
Explanation
This is a main duct intraductal papillary mucinous neoplasm. Any main duct IPMN requires resection because of a high rate of occult invasive carcinoma, and ductal diameter above 10 mm plus a mural nodule are absolute worrisome features pushing toward surgery. Surveillance is inadequate, cystogastrostomy is for pseudocysts, and total pancreatectomy is reserved for selected extensive disease, not first line.
Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.