Symptomatic Metachronous Colorectal Metastasis in the Head of the Pancreas Led To an Emergency Whipple Procedure for Bleeding

Trichkov T, Mihaylov V, Marvakov S, Kostadinov R, Katzarov A, Hartova A, Fakirova A, Katzarov K and Vladov N

Published on: 2022-05-06


Background: Secondary lesions in the pancreatic head are sporadic, occurring with a frequency of 2-3% of all malignant processes of the pancreas. Different studies often originate from renal cell carcinoma (55-70%), while the frequency of secondary lesions arising from colorectal cancer is even lower (6.6-9%). We present a case of a 73-year-old male patient who underwent emergency pancreaticoduodenal resection due to intraluminal bleeding into the common bile duct due to metachronous colorectal metastasis to the head of the pancreas. Primary malignancy was first diagnosed in 2019. Laparoscopic anterior resection was performed on the occasion of metastatic adenocarcinoma of the rectosigmoid. He underwent adjuvant therapy, and in 2020, a right laparoscopic hepatectomy was completed. In December 2021, he underwent ERCP with a SEMS prosthesis due to jaundice. In January 2022, intraluminal bleeding was established, which could not be managed endoscopically, and an emergency surgery treatment with the Whipple procedure was committed.

Methods: We reviewed all case reports and series describing pancreatic resections for secondary pancreatic lesions. For this purpose, we used the "PubMed," "ResearchGate," "UpToDate," "Medline," and "Google Scholar" databases.

Results: In our case, we found a bleeding metastatic lesion in the head of the pancreas, which was successfully removed. The patient was discharged without complications.

Conclusion: Despite few data on the benefits of surgical treatment of secondary lesions in the pancreas originating from other than renal cell carcinoma, recent series have shown promising data on disease-free periods and low postoperative mortality.