{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:10:04Z","timestamp":1756318204869,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,4,3]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>A female patient in her 50s presented with abdominal pain, nausea and jaundice. She had a history of prior Roux-en-Y gastric bypass and her body mass index was 52.5 kg\/m<jats:sup>2<\/jats:sup>. Biochemical testing revealed a total bilirubin level of 14.3\u2009mg\/dL (normal&lt;1.2\u2009mg\/dL) and carbohydrate antigen 19\u20139 of 38.3 units\/mL (normal&lt;36.0 units\/mL). CT demonstrated a 3.2\u2009cm pancreatic head mass, biliary and pancreatic duct dilation and cystic replacement of the pancreas. The findings were consistent with a diagnosis of mixed-type intraductal papillary mucinous neoplasm (IPMN) with invasive malignancy. The patient\u2019s Roux-en-Y anatomy precluded endoscopic biopsy, and she underwent upfront resection with diagnostic laparoscopy, open total pancreatectomy, splenectomy and remnant gastrectomy with reconstruction. Pathology confirmed T2N1 pancreatic adenocarcinoma, 1\/29 lymph nodes positive and diffuse IPMN. She completed adjuvant chemotherapy. IPMNs have malignant potential and upfront surgical resection should be considered without biopsy in the appropriate clinical setting.<\/jats:p>","DOI":"10.1136\/bcr-2023-258071","type":"journal-article","created":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T22:41:11Z","timestamp":1712702471000},"page":"e258071","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Total pancreatectomy, splenectomy and remnant gastrectomy for invasive intraductal papillary mucinous neoplasm (IPMN) after prior Roux-en-Y gastric bypass"],"prefix":"10.1136","volume":"17","author":[{"given":"Joanna T","family":"Buchheit","sequence":"first","affiliation":[{"name":"Penn State College of Medicine, Hershey, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isha","family":"Joshi","sequence":"additional","affiliation":[{"name":"Penn State College of Medicine, Hershey, Pennsylvania, 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