A 47 years old caucasian woman presented to the ED with significant abdominal pain, vomiting and abdominal distension. She presented denied any a medical history and any therapy. Her vital signs were: blood pressure, 130/70 mm Hg; respiratory rate, 30 breaths/minute; heart rate, 70 beats/minute and temperature of 36°C. Oxygen saturation was 95% on room air. The abdominal examination showed an abnomarl mass in epigastric region. Thoracic examination reported reduced vesicular murmur. Laboratory evaluation revealed normal leukocytosis with a white blood cell (WBC) count of 9 per mm³. Arterial Blood Gases (ABG) was normal. Abdominal computed tomography revealed a giant cystic mass in left pancreas and adhesion with stomach and colon trasversum. An open laparotomy showed a voluminous cystic lesions in distal pancreas. En block spleno-pancreatectomy following trasversum resection and colo-colo anastomosis was performed. Histopathological findings showed a 14 x 9 cm mucinous adenoma with cellular atipias. After a pancreatic fistulas Grade A, the patient was discharged 10 days after.

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Corresponding author
Danilo Coco, Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy (webcostruction@msn.com)