Case 13


A 62-year-old gentleman is admitted for a chest infection. He has a past history of nasopharyngeal carcinoma and pulmonary tuberculosis. A chest computed tomography scan is performed. An incidental finding of a cystic pancreatic dilatation is noted. He denies any abdominal pain, weight loss or change in bowel habit.

Physical examination

Afebrile, pulse 80 bpm, BP 115/78mmHg, SaO2 96% on RA.

Hydration is satisfactory.

Examination of the hands reveals no clubbing and normal-appearing palmar creases.

Head and neck examination is unremarkable.

Cardiovascular: HS dual, no murmur.

His chest is clear on auscultation.

Abdominal examination reveals a soft, non-tender abdomen, with no definite mass palpable.

No signs of oedema.



WBC 5.8 x 109/L;

haemoglobin 11.8g/dL;

platelets 283 x 109/L.

ALP 138 IU/L.

ALT 16 IU/L.

Bilirubin 4μmol/L.

Amylase 81 IU/L.

CA 19.9 is 457 kIU/L (reference range is <18).

What would you do next?

A formal CT of the abdomen and pelvis with contrast (Figure 13.1).

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Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 13

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