An intrapapillary pancreatic duct diverticulum: A rare but surgically correctable cause of juvenile pancreatitis

Abstract

An 1 I-year-old girl presented with a 6-year history of abdominal pain. The attacks of 3-4 hours' duration started in the epigastrium, radiated to the back and were relieved by leaning forward. There was no history of rigors or jaundice. As she lived on a remote farm, medical attention was often delayed, and examination and blood tests between attacks were normal, including a barium meal, oral cholecystogram and GTT. On one occasion, on the day after an acute attack, the serum amylase was elevated, so she was referred for further investigation.She was a plump, well-nourished girl with no abnormal physical findings. A11 routine haematological and biochemical screening tests were normal. The serum amylase was 155 u/l (normal range 70-300); GTT normal; 3 day faecal fat 10.5 mmol/d (normal range 0-19). Serum lipid profile and serum and urinary amino profile were normal. Straight abdominal X-ray was normal, as was an ultrasound scan.On endoscopy, the second part of the duodenum was normal but the papilla of Vater was enlarged with a bulge above the papillary orifice. The pancreatogram demonstrated a small diverticulum arising superiorly from the origin of the pancreatic duct within the papilla (Fig. 1). There was slight irregularity of the side ducts and main duct in the distal body and tail of the pancreas compatible with minimal pancreatitis (Fig. 2). The biliary system was normal and drained via a separate orifice.