Occurrence of an adenocarcinoma at the choledochoenteric anastomosis 14 years after pancreatoduodenectomy for benign disease.

A 35-year-old man underwent a pancreatoduodenectomy for what proved to be chronic pancreatitis. He did well until 14 years later, when he presented with right upper quadrant pain and jaundice. At laparotomy, an adenocarcinoma was found in fibrous tissue obstructing the choledochoenteric anastomosis. The exact origin of the tumor, from pancreas or biliary tract, could not be ascertained. This case points out the difficulties in attempting to diagnose the etiology of jaundice in a patient who has had a pancreatoduodenectomy without doing a laparotomy. The importance of this diagnosis lies in the known occurrence of benign strictures at the choledochojejunostomy site after a pancreatoduodenectomy.