Eight months earlier, a 71-year-old man developed acute-onset severe abdominal pain following alcohol consumption. Following a 2-day onset, on admission, laboratory testing revealed serum lipase levels exceeding three times the upper limit of normal, and contrast-enhanced CT demonstrated features of acute pancreatitis, including a walled-off fluid collection near the splenic hilum. He improved with conservative management but subsequently developed recurrent postprandial abdominal pain and progressive enlargement of a left upper quadrant mass.
He had no relevant medical or surgical history but reported long-term heavy alcohol consumption and a 12.5-kg unintentional weight loss. Laboratory tests showed hypoalbuminaemia and elevated lactate dehydrogenase (LDH), while serum carbohydrate antigen 19-9 (CA19-9) and IgG4 were within normal limits.
Repeat CT demonstrated enlargement of the pancreatic cystic lesion to 9 cm with splenic involvement (