Ansa pancreatica

Case contributed by Dr Utkarsh Kabra

Presentation

Pain in the right hypochondrium.

Patient Data

Age: 65 years
Gender: Female

Sternotomy sutures are seen in situ.

The study reveals contracted gall bladder with multiple tiny calculi filling the entire lumen. No obvious pericholecystic edema/fluid seen.

CBD is mildly prominent with smooth distal tapering. Mid CBD diameter is approx. 7.2mm.

Accessory pancreatic duct(duct of Santorini) is seen to arise from MPD in body region. It is seen to descend down, then ascend upwards, forming a loop and finally terminating in the minor papilla. MPD is seen to drain at its conventional location at major papilla.

No obvious side branch dilatation seen.

Pancreatic tail appears mildly bulky with peripancreatic fat stranding in keeping with pancreatitis.

Liver, spleen and kidneys are unremarkable.

Case Discussion

Accessory pancreatic duct(duct of Santorini) is seen to arise from MPD in the body region. It is seen to descend down, then ascend upwards, forming a loop and finally terminating in the minor papilla. MPD is seen to drain at its conventional location at major papilla. Findings consistent with ansa pancreatica.

Contracted gall bladder with multiple tiny calculi filling the entire lumen consistent with chronic calculous cholecystitis.

The value of identifying an ansa pancreatica which is an anatomical variant of pancreatic duct lies in the fact that it predisposes to idiopathic acute pancreatitis.

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