Introduction: Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy, often presenting with nonspecific symptoms and late diagnosis. The global incidence of pancreatic cancer has increased by approximately 9% from 1990 to 2021, with the highest rates observed in high-SDI regions and the lowest in low-SDI regions. A dilated main pancreatic duct (MPD) is a known indicator of malignancy and plays a significant role in surgical planning and outcomes. Case Presentation: We report a rare case of a 50-year-old woman with PDAC presenting with extraordinary MPD dilatation measuring 2 cm. The patient exhibited symptoms of abdominal pain and obstructive jaundice. Imaging revealed a pancreatic head mass with ductal and biliary obstruction, accompanied by intraductal calcification. She underwent a pancreaticoduodenectomy (PD) with duct-to-mucosa pancreaticojejunostomy (PJ), facilitated by the firm consistency of the pancreas and the markedly dilated MPD. Histopathology confirmed a well-differentiated stage 1B PDAC with no lymphovascular invasion. Postoperative recovery was uneventful, and the patient completed adjuvant chemotherapy with a complete response based on RECIST criteria. Discussion: PD is the standard treatment for resectable PDAC, though it carries high complication risks, especially postoperative pancreatic fistula (POPF). This case highlights successful duct-to-mucosa PJ in a patient with favorable anatomy, minimizing POPF risk. Postoperative drain monitoring showed no POPF, and the patient had an excellent recovery. Adjuvant chemotherapy was administered to reduce recurrence risk due to potential micro-metastatic disease. Conclusion: This case illustrates the surgical advantage provided by significant dilatation of the MPD in PDAC, which can reduce the risk of POPF and improve patient outcomes. Early detection and appropriate surgical technique are critical in the management of PDAC.
Rowika et al. (2026) studied this question.