Abstract Intraductal papillary mucinous neoplasms (IPMN) are increasing in incidence due to more frequent imaging. While most tumors are asymptomatic, some may present with vague gastrointestinal symptoms and laboratory findings. Our patient presented to the emergency room with a history of abdominal pain, vomiting, diarrhea, and a “burning” upper epigastric pain. Evaluation was significant for elevated AST, ALT, and glucose with a CA19-9 of 62.2. Imaging and pathology were suggestive of pancreatic malignancy. As with our patient, clinical suspicion should remain high when older individuals present with new onset diabetes and GI unrest which should warrant further evaluation.

Keywords: Pancreatic adenocarcinoma; IPMN; Pancreas; Hyperglycemia; Pancreatic divisum