Pancreatic involvement in acute lymphoblastic leukaemia is rare [1, 2, 3] and obstructive jaundice secondary to a pancreatic mass as a primary presentation of acute lymphoblastic leukaemia has not been reported in the surgical literature. Acute lymphoblastic leukaemia typically presents with symptoms of bone marrow failure such as fatigue, lethargy, infections, bruising or bleeding. Approximately half the patients will have lymphadenopathy, splenomegaly or hepatomegaly at presentation. Full blood count may reveal cytopenias or (as in this case) a raised white cell count due to circulating blast cells. Although long term survival in adults is less good than children, acute lymphoblastic leukaemia is an important diagnosis to make because it is highly chemo-sensitive, with 91% of adults achieving complete remission following induction therapy in the recent UK ALL XII trial . If suspected, a haematological referral is required since the diagnostic procedure of choice is a bone marrow aspirate and trephine.