Abstract
Background
Detecting a neoplasm in pediatric patients with acute abdominal pain is difficult,
especially when there is no palpable mass. Ihara's maneuver, which allows the physician
to apply manual pressure directly on the pancreatic body, is a useful palpation method
of diagnosing acute pancreatitis in children. We report a case of solid pseudopapillary
neoplasm of the pancreas (SPNP) detected by Ihara's maneuver.
Case Report
An otherwise healthy, 15-year-old male visited our emergency department with acute
abdominal pain and nausea. His vital signs were appropriate for his age. A physical
examination denied peritoneal signs, but Ihara's maneuver induced strong tenderness.
His serum amylase and lipase were normal. A contrast-enhanced computed tomography
scan revealed a well-defined, 2.2-cm, nonenhanced mass in the pancreatic tail. Laparoscopic
distal pancreatectomy was performed, and the diagnosis of SPNP was confirmed. The
patient was well postoperatively without any metastasis. SPNP is a rare neoplasm with
low malignant potential. Although it typically occurs in young females, it has also
been reported in children. The early diagnosis of SPNP is usually challenging because
most patients do not have specific symptoms or laboratory findings. In the present
case, the SPNP was difficult to detect by palpation because of its size, but Ihara's
maneuver induced strong tenderness of the pancreas and led to a diagnosis.
Why Should an Emergency Physician Be Aware of This?
Ihara's maneuver has the potential to enable early diagnosis not only of pancreatitis
but also of pancreatic tumors, such as SPNP.
Keywords
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Article info
Publication history
Published online: April 19, 2020
Accepted:
March 18,
2020
Received in revised form:
February 19,
2020
Received:
October 30,
2019
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
