Locally Invasive Pancreatic Adenocarcinoma Presenting in the Splenic Flexure: A Rare Case Report.

Pancreatic adenocarcinoma is a malignant cancer seen predominantly in males presenting with high-risk factors including chronic pancreatitis, familial history of cancer, and tobacco and alcohol abuse. The etiology of pancreatic adenocarcinoma is deceptive, and research continues to investigate its molecular patterns. Herein, we present a case of a 74-year-old Caucasian male who presented to the emergency department (ED) with tarry stools and hematochezia in the rectum for two weeks. Colonoscopy was terminated prematurely due to a mass at 70 cm within the splenic flexure of the colon. Exploratory laparotomy revealed a palpable mass at the splenic flexure invading the spleen. Splenectomy, distal pancreatoduodenectomy, and left hemicolectomy were performed. Pathological imaging revealed locally invasive pancreatic adenocarcinoma presenting in the splenic flexure, pancreatic parenchyma, peripancreatic soft tissue, and colonic wall. The patient is currently undergoing chemotherapy and radiation treatment. Below, we discuss risk factors, pathology, screening methods, and current treatment guidelines regarding pancreatic cancer. When pancreatic adenocarcinoma becomes metastatic, it most commonly involves the liver and lungs, but the review of current literature shows that limited cases of local invasion to the splenic flexure have been reported.