Case 26-1983

Presentation of Case A 65-year-old woman was admitted to the hospital because of a question of recurrent pancreatitis. She was well until five years earlier, when she experienced an attack of pain in the epigastrium, right upper quadrant, and back, accompanied by nausea and jaundice. Laboratory studies showed abnormal results of liver-function tests and an elevated amylase level. The episode subsided, but four bouts of identical symptoms occurred during the succeeding five years. Four months before admission, after the most recent episode of pain, an attempted endoscopic retrograde cholangiopancreatographic (ERCP) examination performed at another hospital revealed a submucosal mass in . . .