Franciscan St. James Hospital Olympia Fields, IL, United States
Chike Nwokolo, DO, MS1, Chetachi Odelugo, DO, MS2, Alex Yarbrough, DO2 1Franciscan St. James Hospital, Olympia Fields, IL; 2Franciscan St. James Health, Olympia Fields, IL
Introduction: In the US, yearly over 57,000 patients are diagnosed with pancreatic adenocarcinoma and prognosis is poor. Variable presentation of pancreatic adenocarcinoma is related to the affected area. Those with pancreatic head tumors often present with painless jaundice, steatorrhea, and weight loss. Peak incidence of pancreatic cancers are 65-69 for men and 75-79 for women.
Case Description/Methods: 88 yo female with pmhx of A Fib, HLD, COPD, HTN presented to the clinic for chronic diarrhea over six months. She also reported weight loss due to dietary changes to control her diabetes and chronic diarrhea. She reported having 2 to 3 loose stools a day most consistent with a bristol stool type 5 to 6. Patient had a normal colonoscopy in 2012. Patient evaluated with fecal lactoferrin, fecal lytes, culture, O&P, pH, fat, and A1AT, and pancreatic fecal elastase would be checked and pending results further recommendations would follow. Differentials included exocrine pancreatic insufficiency, diabetic enteropathy, SIBO and IBS-D. Stool studies suggested severe pancreatic insufficiency, pancreatic elastase of 15, prompting the initiation of pancreatic enzymes. When she returned to the clinic 8 weeks later, she reported stools had become less frequent and more formed. In the setting of her known diabetes with newly diagnosed exocrine pancreatic insufficiency, imaging recommended and patient had a pancreatic protocol CT scan which revealed dilation of the main pancreatic duct and an ill-defined pancreatic head mass measuring 2.4 x 2.0 x 1.6 cm. Patient was then referred for EUS with FNA of the pancreas confirmed poorly differentiated adenocarcinoma with questionable invasion of superior mesenteric vein. Oncology consulted for newly diagnosed pancreatic head adenocarcinoma and started the patient on palliative chemotherapy.
Discussion: This case presents a pancreatic head adenocarcinoma with an atypical clinical presentation. Pancreatic cancer typically presents with symptoms of jaundice, pruritus, lethargy, and weight loss. Infrequently patients present with epigastric pain and backache as well as new onset diabetes mellitus. This case report presents a patient with symptoms of persistent diarrhea which was the only indication for evaluating pancreatic insufficiency and ultimately led to the diagnosis of pancreatic cancer. This unusual presentation makes diarrhea in a patient with extensive family cancer history and diabetes a consideration for pancreatic cancer to be included in differential diagnosis.
Disclosures: Chike Nwokolo indicated no relevant financial relationships. Chetachi Odelugo indicated no relevant financial relationships. Alex Yarbrough indicated no relevant financial relationships.
Chike Nwokolo, DO, MS1, Chetachi Odelugo, DO, MS2, Alex Yarbrough, DO2. P2149 - Can You Guess Who? Diarrhea as a Clue to Pancreatic Cancer, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.