The presentation of pancreatic
adenocarcinoma as acute or
chronic pancreatitis has been well documented; however, there has been only one previous report of either functioning or nonfunctioning pancreatic
neuroendocrine tumors associated with
pancreatitis. At the Medical University of South Carolina in Charleston, from March 1982 through September 1987, we have managed four patients with nonfunctioning
pancreatic islet cell tumors or
carcinoids, which presented with attacks of
pancreatitis. Three of the patients had recurrent bouts of upper abdominal and lower dorsal
back pain with elevation of the serum
amylase. One patient presented initially with acute upper
abdominal pain and elevation of the serum
amylase. Each patient had an endoscopic retrograde cholangeography pancreatography (ERCP) pattern involving the pancreatic duct which was characterized by diffuse dilatation proximal to the site of obstruction. One of the four had a
tumor blush on splanchnic angiography. Each patient had CT evidence of a mass in the head of the pancreas; however, one of the four was found to have diffuse involvement of the entire gland at operation. Surgical
therapy varied: (a) local excision of the ampullary area with re-anastomosis of the pancreatic duct to the duodenum and
choledochoduodenostomy; (b) bypass with cholecystoduodenostomy and caudal
pancreaticojejunostomy; (e) total
pancreatectomy; or (d) bypass with a Roux-en-Y cholecystojejunostomy and
gastrojejunostomy. The choice of the procedure was based on the patient's condition and operative findings.