Acute pancreatitis: pancreas divisum with ventral duct intraductal papillary mucinous neoplasms

Abstract

Acute recurrent pancreatitis occurs rarely in individuals with pancreas divisum. A 39-year-old woman with no significant history presented with pancreatitis. CT scan and MRI suggested acute on chronic pancreatitis with calcifications and pancreatic divisum. An endoscopic ultrasound demonstrated complete pancreas divisum. A large calcification measuring 12 mm × 6 mm was seen in the head of the pancreas with associated dilation of the ventral pancreatic duct. Fine-needle aspiration of the dilated ventral pancreatic duct showed an amylase level of 36,923 U/L and a carcinoembryonic antigen of 194. A ventral duct intraductal papillary mucinous neoplasm was suspected and a pancreaticoduodenectomy procedure was recommended. After the procedure, pathology demonstrated an intraductal papillary lesion in the main duct with moderate dysplasia. A pancreatic intraepithelial neoplasia, grade 2 was also present. Margins of resection were clear. This case represents the importance of assessing for secondary causes of pancreatitis in pancreas divisum.

Establishment of a Model for Predicting the Recurrence of Recurrent Acute Pancreatitis in A Short Period of Time

“…RAP still represents a challenging disease, repeated episodes of which contribute substantially to the overall disease burden by prompting repeated hospitalization, adversely impacting quality of life as well as increasing the risk of progression to chronic pancreatitis and pancreatic tumor [2,[11][12][13][14]. RAP may run a milder clinical course than an index episode [15,16], but the fatality rate of which was signi cantly higher than that of patients with rst-episode AP [17].…”

Bridging the Divisum: A Rare Case of Pancreaticopleural Fistula in the Setting of Complete Pancreatic Divisum Treated Endoscopically

“…Another key finding in our patient was the presence of a complete pancreatic divisum, which is an embryological defect in the fusion of the dorsal or ventral pancreatic ducts present in 5% to 10% of the population. 16 , 17 This results in pancreatic fluid being diverted to the minor pancreatic duct leading to an obstruction in outflow, predisposing to pancreatitis. Although typically asymptomatic, it has been reported to increase the risk of pancreatitis.…”

Treatment of Difficult Minor Papilla Cannulation in Patients of Pancreatic Divisum: Using Endoscopic Ultrasonography–guided Puncture Combined With Endoscopic Retrograde Cholangiopancreatography: 2 Cases and Literature Review

“…9 Moreover, there has been not a few documents report that there is a correlation between PD and pancreatic tumors. [10][11][12][13] In view of the above considerations, the endoscopic therapy in patients of PD remains an individualized decision, and its true long-term benefit should be confirmed by further prospective randomized controlled trials. Our research team tends to think that endoscopic therapy was superior to surgery since it is anyhow a minimally invasive, relatively safe, and useful platform.…”