Multidisciplinary Management of Pancreatic Head Adenocarcinoma Presenting with Painless Obstructive Jaundice

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) often presents late with nonspecific symptoms, particularly in elderly patients with multiple comorbidities. The “double-duct sign”, characterized by simultaneous dilation of the common bile duct (CBD) and main pancreatic duct (PD), is a radiologic indicator of pancreatic head or peri-ampullary malignancy. Multidisciplinary management is critical to optimize diagnostic accuracy, therapeutic interventions, and patient-centered care. Case Presentation: An 82-year-old female with a history of cerebrovascular accident, hypothyroidism, asthma, osteoarthritis, migraine headaches, gastroesophageal reflux disease, and prior cholecystectomy presented with early satiety, progressive unintentional weight loss over several months, and visible jaundice noted by a friend. Laboratory evaluation revealed marked hyperbilirubinemia and significantly elevated CA 19-9 (~2390 U/mL). Imaging demonstrated a dilated CBD and PD consistent with the double-duct sign and a small mass in the head/uncinate process of the pancreas. ERCP with stent placement relieved the obstruction. EUS-guided fine-needle biopsy confirmed adenocarcinoma. Multidisciplinary involvement, including Gastroenterology, Surgical Oncology, Hematology/Oncology, Pulmonology, Nutrition, and Palliative Care, guided staging, aspiration risk management due to severe esophageal dysmotility, nutritional optimization, and goals-of-care planning. Conclusion: Early recognition of subtle clinical signs, timely endoscopic tissue acquisition, and coordinated multidisciplinary care are essential in managing elderly patients with pancreatic head adenocarcinoma. Comprehensive management mitigates complications, addresses quality-of-life concerns, and aligns treatment with patient-centered goals.