Nasir Khokhar.
Missed Carcinoma of Pancreas at open Cholecystectomy.
Pak J Med Sci Jan ;19(2):136-7.

This patient was 53 years old male, who presented at another hospital with the constipation, abdominal heaviness and vague abdominal pain. He had fifteen years history of smoking one packet of cigarettes per day but denied any intake of alcohol. He had history of hypertension and had been on Metoprolol and Captopril for past six years. His physical examination showed normal vital signs. Abdominal examination showed no masses or tenderness. Abdominal sonography revealed multiple gallstones. He underwent open cholecystectomy. His abdominal pain, however, did not improve and, in fact, worsened and he presented to our hospital where he was found to have a wound which had healed well. His laboratory findings showed hemoglobin of 12.2 g/dl, hemotocrit was 38%, WBC count was 12800 /ul, platelet were 333,000, total bilirubin was 0.8, direct bilirubin was 0.24, AST was 31 U/l, ALT 54 U/l, alkaline phosphatase was 275 (Normal 39-117), creatinine was 0.7 mg/dl, serum amylase was 99 U/l (Normal 28-100 U/l), serum lipase was 90 (Normal <190). Abdominal sonography at this time showed a mass in the pancreas which was confirmed on the CT scan which revealed 5 x 5.5 cm mass in the body with retroperitoneal lymphadenopathy. CT directed fine needle aspiration was positive for malignant cells. Patient refused any further surgery.

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