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
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 favor 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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