Figure - available from: Case Reports in Medicine
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MRCP of the patient showing the accessory duct of Santorini suggestive of pancreatic divisum (yellow arrows show the accessory duct of Santorini, and red arrows show the main pancreatic duct).
Source publication
Pancreatic Divisum (PD) is the most common congenital variation of pancreatic duct anatomy, arising when embryological ventral and dorsal endodermal buds fail to fuse (“classic” PD) or only fuse partially (“incomplete” PD). Most patients with PD are asymptomatic, but a subgroup of patients can present with recurrent bouts of pancreatitis. While alc...
Citations
... [2] However, only 5% of the population becomes symptomatic for reasons unknown. [3] A brief review of the literature in the same age group suggests that PD is a risk factor for acute recurrent pancreatitis and chronic pancreatitis in children independent of the genetic risk factors as per an analysis by Lin et al. in 52 patients with PD. [5] Endotherapy in the form of ERCP and sphincterotomy has been found to be safe and effective in the pediatric age group as per studies by [2,3,[5][6][7][8][9] In a study on seven patients, Snajdauf et al. reported improvement in three patients following ERCP, unsuccessful papillotomy in three patients, and recurrent pancreatitis requiring duodenum preserving pancreatic head resection in one patient. [10] Associations with choledochal cyst, abnormal pancreaticobiliary junction, and malrotation have also been reported. ...
... [2] However, only 5% of the population becomes symptomatic for reasons unknown. [3] A brief review of the literature in the same age group suggests that PD is a risk factor for acute recurrent pancreatitis and chronic pancreatitis in children independent of the genetic risk factors as per an analysis by Lin et al. in 52 patients with PD. [5] Endotherapy in the form of ERCP and sphincterotomy has been found to be safe and effective in the pediatric age group as per studies by [2,3,[5][6][7][8][9] In a study on seven patients, Snajdauf et al. reported improvement in three patients following ERCP, unsuccessful papillotomy in three patients, and recurrent pancreatitis requiring duodenum preserving pancreatic head resection in one patient. [10] Associations with choledochal cyst, abnormal pancreaticobiliary junction, and malrotation have also been reported. ...
... [1,2] Its incidence is 4%-14%, although lower (1%-2%) in the Asian population. [3] Three types have been described. In Type 1, there is a total failure guardian has given his consent for images and other clinical information to be reported in the journal. ...
... 5,6 A Google Scholar search with the term "Pancreaticopleural fistula" yielded 1 more article. 7 Clinical features of the 4 other cases have been summarized in Table 1. ...
... 18 It is likely that our patient's anatomic predisposition increased her risk for a PPF as has been noted in literature. 4,6,7,19 To conclude, pleural effusions due to PPF can be especially difficult to diagnose. 4 Suspicion should rise when there is persistent pleural effusion despite adequate treatment for common causes, such as heart failure or pneumonia. ...
... To our knowledge, this is the fifth reported case of a PPF in the setting of pancreatic divisum and the first case reported in a middleaged female. [4][5][6][7] ...
A pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis that occurs either due to a pancreatic duct disruption or a pseudocyst extension. A pancreatic divisum, on the other hand, is a common anatomic variant of the pancreas that is rarely symptomatic. We describe a case of recurrent pleural effusion in a patient with a history of chronic pancreatitis. Investigations revealed the presence of a PPF and a concomitant complete pancreatic divisum. There was resolution of the pleural effusion on endoscopic therapy. This is the fourth reported case of a PPF in the setting of complete pancreatic divisum and the first reported case in a middle-aged female.
