The authors report the case of a 74 year-old woman who was hospitalized for severe abdominal pain. The patient had epigastralgia for many years. Biology revealed hyperamylasemia and computerized tomodensitometry showed that the pancreas head was enlarged. At retrograde wirsungography a short stenosis was visible in the pancreatic duct, 2 cm from the papilla. This was considered to be a tumor and surgery was performed. Histological sections of the pancreatic head showed strictly intraductal carcinoma "de novo" or associated with ductal epithelial hyperplasia. Although very rare, in situ carcinoma should be considered when clinical features are unexplained in order to perform radical surgery.