Table of Contents    
Case Report
 
Total pancreatectomy for cholangiocarcinoma of the distal common bile duct associated with lipomatous pseudohypertrophy of pancreas
Subani Priyangika Jayatunge1, Gayana Mahendra2, Sajith Siyabalapitiya3, Rohan Chaminda Siriwardana4, Chandika Liyanage4
1MBBS, Trainee, Hepato-Pancreatico-Biliary Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
2MBBS, Dip.Path, MD Hist.Path, Consultant Histopathologist, Department of Pathology, Faculty of Medicine, Ragama, Sri Lanka.
3MBBS, MD, MRCP, Counsultant Endocrinologist, North Colombo Teaching Hospital, Ragama, Sri Lanka.
4MBBS, MS, MRCS, Consultant GI and Hepato-Pancreatico-Biliary Surgeon, North Colombo Teaching Hospital, Ragama, Sri Lanka.

Article ID: 100031IJHPDSJ2015
doi:10.5348/ijhpd-2015-31-CR-6

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Sri Lanka
Phone: 0094 0774612926
Fax: 0094 0112958337

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How to cite this article:
Jayatunge SP, Mahendra G, Siyabalapitiya SS, Siriwardana RC, Liyanage C. Total pancreatectomy for cholangiocarcinoma of the distal common bile duct associated with lipomatous pseudohypertrophy of pancreas. Int J Hepatobiliary Pancreat Dis 2015;5:30–34.


Abstract
Introduction: Fatty replacement of the exocrine pancreas also known as lipomatosis, adipose atrophy or lipomatous pseudohypertrophy is a well recognize benign condition. This fatty infiltration can occur either focally or involving the whole pancreas.
Case Report: We report a rare case of lipomatous pseudohypertrophy of the pancreas associated with cholangiocarcinoma of the distal common bile duct (CBD). A 51-year-old female presented to our unit with a history of obstructive jaundice. Radiological imaging suggested a cholangiocarcinoma of the distal CBD with pancreatic lipomatosis, without any clinical evidence of exocrine or endocrine dysfunction. She underwent a radical bile duct excision and a total pancreatectomy. Histology revealed lipomatosis of the pancreatic body and tail with sparse pancreatic tissue adjacent to the tumor. After an uneventful recovery, she was started on lifelong insulin and pancreatic enzyme supplements. Even though pathogenesis of pancreatic lipomatosis remains controversial, it is most likely due to obstruction of the pancreatic duct in this presentation.
Conclusion: It is import to undertake total pancreatectomy for this dual presentation with specialized endocrinological support in the stormy postoperative period.

Keywords: Cholangiocarcinoma, Lipomatous pseudohypertrophy of the pancreas, Total pancreatectomy


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Author Contributions
Subani Priyangika Jayatunge – Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Gayana Mahendra – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Sajith Siyabalapitiya – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rohan Chaminda Siriwardana – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Chandika Liyanage – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Subani Priyangika Jayatunge et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Subani Jayatunge is a Trainee at Department of Surgery, Faculty of medicine, University of Kelaniya, Ragama, Sri Lanka. She earned the undergraduate degree (MBBS) from Faculty of Medicine , University of Kelaniya, Ragama, Sri Lanka in 2012. Her research interests include Hepatobiliary surgery.



Gayana Mahendra is Senior Lecturer at Department of Pathology, Faculty of Medicine , University of Kelaniya, Sri Lanka. She earned the undergraduate degree from Faculty of Medicine, University of Colombo, Sri Lanka and postgraduate degrees form Post Graduate Institute of Medicine, University of Colombo, Sri Lanka. She has published research papers in national and international academic journals. Her research interests include soft tissue and bone pathology and gastrointestinal pathology



Sajith Siyabalapitiya is Consultant Endocrinologist at North Colombo Teaching Hospital, Ragama, Sri Lanka. He has published research papers in national and international academic journals.



Rohan Chaminda Siriwardanais a Senior Lecturer, Consultant GI, HPB and Liver Transplant Surgeon at Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. He has published many research papers in national and international academic journals and his research interests include hepatobiliary and liver transplant surgery.



Chandika Liyange is a Senior Lecturer at Department of Surgery, Faculty of medicine, University of Kelaniya, Ragama, Sri Lanka.