Figure 2 - uploaded by Norman Oneil Machado
Content may be subject to copyright.
MRCP showing pancreatic Divisum of incomplete type- Small communication noted (straight narrow arrow) between the prominent dorsal duct (curved arrow) draining through minor papilla and the ventral duct along with CBD (broad straight arrow) opening through the major papilla.
Source publication
In over 90% of healthy people, the dorsal and ventral endodermal pancreatic buds fuse to form the adult
pancreas. However, in about the remaining 10% of the population where the fusion does not occur, pancreatic
divisum (PD) results. This indeed is the commonest congenital anomaly of pancreas. The dorsal root usually drains
a part of pancreatic hea...
Citations
... Laboratories examination showed a lipase 3 times higher than normal at 498 UI/L (normal range < 160 UI/L), with a Creactive protein at 53 mg/L (normal range < 5 mg/L) and creatinine at 3.7 mg/L (normal range 6.7-11.7 mg/L). The white blood cell count was 4100 cells/mm 3 (normal range 4000-11,000 elements/mm 3 ), and hemoglobin at 13.1 g/dL (normal range 13.0-18.0 g/dL). ...
Pancreas divisum (PD) is the most common congenital variant of the pancreatic ductal system, in which only a few patients develop symptomatic disease. Overall, PD is an underrecognized cause of many cases of recurrent acute pancreatitis. The PD must be systematically suspected in case of multiple episodes of acute idiopathic pancreatitis when exhaustive etiological investigations are negative. We present a 37-year-old woman whom presented several previous pancreatic pains. She came to the emergency department for epigastric pain, accompanied by post-prandial dietary vomiting after a copious meal. Lipasemia was greater than 3 times normal (498 UI/L). An abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed a PD. The patient improved after the initial management measures. An endoscopic cholangiopancreatography was planned after the resolution of the acute episode. Recurrent pancreatitis is defined as 2 or more episodes of distinct acute pancreatitis with more than 3 months between episodes. Patients with this condition are usually asymptomatic while 5% of patients develop acute pancreatitis or chronic pancreatitis. We can underline the interest of deepening the radiological and endoscopic investigations to make the diagnosis of PD and to propose an endoscopic or surgical treatment, in order to avoid recurrences.
Introduction
and importance: In children, acute recurrent pancreatitis is attributed to pancreato-biliary anomalies, hereditary pancreatitis and cystic fibrosis. Pancreatic divisum is a common congenital ductal anomaly that leads to recurrence of pancreatitis.
Case presentation
A 13 years old female presented with clinical features of acute recurrent pancreatitis. After ruling out common causes, magnetic resonance cholangiopancreatography was done which showed pancreatic divisum. Her symptoms resolved following duodenum preserving pancreatic head resection.
Discussion
Acute recurrent pancreatitis is attributed to raised intrapancreatic dorsal ductal pressure due to ductal anomalies especially pancreatic divisum (PD). It is the embryological failure in the fusion of the dorsal and ventral ductal system. PD is further classified into a classical subtype where there is complete failure of ductal fusion and an incomplete subtype where there is partial fusion of the ductal system. The diagnosis is commonly done through abdominal imaging with secretin enhanced magnetic resonance cholangiopancreatography being the choice of imaging modality. The initial approach is endoscopic intervention unless patients present with signs of pancreatic fibrosis where a duodenum preserving pancreatic head resection can be carried out.
Conclusion
A keen suspicion should be given towards anatomical or structural variants in absence of common etiologies. Early identification and management of pancreatic divisum prevents the recurrence of pancreatitis.
