Case report
A 35-year-old female presented at the Department of General Surgery, Tribhuvan University Teaching Hospital in Kathmandu, Nepal, complaining of pain in the upper middle and right upper abdomen for the past year. The pain was intermittent, not radiating to other areas of the abdomen, but had worsened over the past month. She also experienced episodes of vomiting, significant weight loss of approximately 6 kg, and shortness of breath while sitting or lying down. There was no history of fever, jaundice, loss of appetite, itching, dark stools, or pale-colored stool.
During the abdominal examination, a firm, smooth, non-tender mass measuring approximately 10x14 cm was detected in the upper middle and right upper abdomen. Abdominal ultrasound revealed signs of acute pancreatitis with the presence of a pseudocyst and a mass in the gallbladder. The levels of CEA (Carcinoembryonic Antigen) were measured at 1.5, and CA 19.9 (Cancer Antigen 19-9) was less than 1.4. Upper gastrointestinal (UGI) endoscopy showed a bulge in the first part of the duodenum (D1), possibly due to external compression (Figure 1).