An 86 year old man was investigated for haematuria 18 months ago. The abdominalCT scan did not show any renal abnormalities but there was “incidental” massive dilatation of the entire pancreatic duct. He was thought to have main duct Intraductal Papillary Mucinous Neoplasm (MD-IPMN) and, after MDT discussion, was managed conservatively. He now presents with jaundice, 2 stoneweight loss and probable cholangitis. Bilirubin 110 umol/L, Alk phosp 990 (NR
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