Uncommon Encounter of Colonic Obstruction as the Initial Presentation of Metastatic Distal Pancreatic Cancer: A Case Report

Abstract

Pancreatic carcinoma poses a significant global health threat ranking as 6th leading cause of cancer-related deaths. Distal pancreatic cancer, located in the body and tail of the pancreas, presents unique challenges due to delayed diagnosis and often advanced stages at presentation. This case report highlights a rare occurrence of metastatic distal pancreatic cancer causing acute colonic obstruction without colonic metastasis as the primary clinical manifestation. A 68-year-old diabetic and hypertensive male presented to the emergency department with diffuse abdominal pain, bilious vomiting, and obstipation. Computed tomography revealed a hypodense mass in the tail of the pancreas, causing desmoplastic reactions leading to severe luminal narrowing and colonic dilatation. Elevated cancer antigen (CA) 19–9 and CEA levels further indicated malignancy. Emergency exploratory laparotomy revealed an infiltrative pancreatic tumor necessitating distal pancreatectomy, splenectomy, sleeve resection of the stomach, subtotal colectomy, and rectal stump closure. The postoperative course was unremarkable, and histopathological examination confirmed locally advanced moderately differentiated distal pancreatic carcinoma with acute colonic obstruction. We emphasize the aggressive nature of distal pancreatic cancer, often diagnosed at advanced stages. Locally advanced pancreatic cancer (LAPC) poses challenges for curative resection, and management focuses on disease control, symptom alleviation, and maintaining quality of life. Desmoplasia's role in pancreatic malignancy is underscored, impacting tumor microenvironment, chemoresistance, and complications like intestinal obstruction. In conclusion we stress the importance of a comprehensive, individualized approach to pancreatic cancer management. Understanding the intricate interaction between cancer cells and the microenvironment, particularly desmoplastic reactions, is evolving. Further research into diagnostic modalities and targeted treatments for desmoplastic reactions is essential for improving outcomes in pancreatic cancer.