Pancreas divisum

Case contributed by Dr Varun Babu

Presentation

Recurrent pancreatitis now presenting during another acute episode

Patient Data

Age: 40 years
Gender: Male
CT

CT abdomen

Mild generalized decrease in volume of pancreas for age. Pancreas is diffusely surrounded by fat stranding and edema with area of mild non localized fluid in the lesser sac, right anterior pararenal fascia. Mild thickening of bilateral anterior pararenal fascia with few peripancreatic, portocaval and porta hepatis discrete enhancing subcentimetric lymph nodes. No areas of parenchymal pancreatic necrosis. No splenic artery aneurysm or splenic vein thrombosis. No pancreatic parenchymal calcification. 

Independent dominant caliber of dorsal duct of Santorini draining separately into minor papilla. The ventral duct also joins the dorsal duct, whilst the CBD drains independently at the major papilla. 

CT

Curve planar reconstruction of the CT abdomen

  • Curved planar reconstruction of the dominant duct of Santorini entering independently in minor papilla with focal dilatation proximal to its duodenal insertion - santorinicele.
  • Curved planar reconstruction of independent normal caliber common bile duct as it enters the major papilla.
Annotated image

Curved planar reconstructions alond the pancreatic and common bile ducts with annotated anatomy 

Case Discussion

Young patients with recurrent pancreatitis warrants work up to understand if there are any anatomical variations /  developmental anomalies of the pancreatic ductal system especially in the absence of any form of biliary calcular disease. Interestingly this patient had a CT scan done 6 years ago and was reported as a case of mild acute pancreatitis. On careful review of the ductal system in the present scan, it was identified this patient has two independent drainage path for both pancreas and the rest of the biliary tree. 

In events of idiopathic recurrent pancreatitis, pancreas divisum can be considered as an underlying etiology. An MRCP may be done for confirmation and the gastroenterologist may opt for a therapeutic ERCP. 

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Case information

rID: 54983
Published: 12th Aug 2017
Last edited: 17th Aug 2019
Inclusion in quiz mode: Included
Institution: Vivid Diagnostic Centre

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