Pancreas divisum

Case contributed by Dr Deepali Brahmachari

Presentation

A patient presented with upper abdominal pain. His laboratory profile showed an elevated Lipase of 22,000 units. There was a prior history of acute pancreatitis, one year before, which resolved without complications. No history of gallstones or alcoholism

Patient Data

Age: 60 years
Gender: Male
MRI

Large dorsal pancreatic duct measuring 3 mm in diameter and opening into minor papilla along the medial border of second part of the duodenum.

A smaller ventral duct measuring 1.5 mm in the pancreatic head is seen which joins distal common bile duct, to open into major papilla along the second part of the duodenum . A small branch from ventral duct also joins dorsal duct.

CBD is normal and measures 4 mm in diameter. Gallbladder and cystic duct are normal. Intrahepatic biliary radicles are normal. Pancreas appears normal. No intraductal filling defects or cystic lesions are noted.

These findings favour a diagnosis of pancreas divisum.

Case Discussion

A non-alcoholic patient with no evidence of gallstones presented with a second episode of abdominal pain and clinicopathological diagnosis of acute pancreatitis. MRCP was requested by the clinician with suspicion of pancreas divisum in this case of idiopathic pancreatitis.

MRCP shows a large dorsal duct draining the pancreas and opening into minor papilla along the medial border of second part of the duodenum. A small ventral duct is seen in the pancreatic head which joins the distal CBD to then open into major papilla along the medial border of second part of the duodenum. A small branch from ventral duct also joins the dorsal duct. No evidence of any cyst or filling defects related to ducts is seen. Pancreas divisum is a developmental anomaly with partial or complete failure of fusion of dorsal and ventral buds. 

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Case information

rID: 58081
Published: 15th Feb 2018
Last edited: 15th Feb 2018
Inclusion in quiz mode: Included
Institution: SHALBY HOPSITAL NARODA

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