[Subcutaneous metastasis after laparoscopic cholecystectomy in a patient with unsuspected adenocarcinoma of the pancreas.].

A 63 year old patient underwent uneventful laparoscopic cholecystectomy in 1994. The patient had a long history of biliary colic after fatty meals. The chief presenting symptom was pain localized in the epigastrium radiating to the back and later distributing to the whole abdomen. The patient also had a history of constipation, but no other symptoms were noted. An ultrasonogram of the liver, gall bladder and pancreas was reported to show calculi in the gall bladder but otherwise normal findings. The laparascopic cholecystectomy was uneventful with discharge the following day. The symptoms however did not disappear, changing in character, locating at the center of the abdomen. The patient began to lose appetite with bouts of diarrhea. The symptoms gradually increased and the patient was admitted to the hospital. Upon arrival the patient was found to have diffuse abdominal pain with a painful swelling of the umbilical trocar site. Incarcerated hernia was suspected, but proved to be a mass at exploration. Pathologic examination disclosed a metastatic adenocarcinoma. A similar but smaller mass was also discovered in the epigastric trocar site. CT scan showed a pancreatic carcinoma of the corpus with infiltration. The patient deteriorated rapidly and died four months after the diagnosis of pancreatic cancer.