Ansa pancreatica as a predisposing factor for recurrent acute pancreatitis

Abstract

AIMTo determine the non-biased prevalence and clinical significance of ansa pancreatica in patients with acute pancreatitis using magnetic resonance imaging (MRI).METHODSOur institutional review board approved this cross-sectional study, which consisted of a community-based cohort of 587 consecutive participants in a whole-body health-check program, and 73 subjects with episode of acute pancreatitis (55 patients with a single episode of acute pancreatitis, and 18 patients with recurrent acute pancreatitis). All of the subjects underwent abdominal MRI including magnetic resonance cholangiopancreatography, medical examinations, and blood tests. Two board-certified, diagnostic, abdominal radiologists evaluated the images, and ansa pancreatica was diagnosed based on its characteristic anatomy on MRI.RESULTSCompared with the community group [5/587 (0.85%)], patients with recurrent acute pancreatitis had a significantly higher frequency of ansa pancreatica [2/18 (11.1%)] (P = 0.016; OR = 14.3; 95%CI: 1.27-96.1), but not compared with patients with single-episode acute pancreatitis [1/55 (1.8%)] (P = 0.42; OR = 2.1; 95%CI: 0.44-19.7). Multiple logistic regression analysis using age, alcohol intake, presence of ansa pancreatica, and presence of autoimmune disease as independent covariates, revealed a significant relationship between the presence of ansa pancreatica and recurrent acute pancreatitis. The presence of autoimmune disease was also significantly associated with the onset of recurrent acute pancreatitis. On the other hand, neither age nor alcohol intake were significantly related to the onset of recurrent acute pancreatitis.CONCLUSIONThe present study is the first to provide robust evidence that the presence of ansa pancreatica is significantly associated with recurrent acute pancreatitis.

Pancreatic Duct Variations and the Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

“…Many studies have hypothesized ansa pancreatica as a risk factor for acute pancreatitis [40,41]. This hypothesis is supported by the findings of a recent case-control study which reported a significantly higher risk of recurrent acute pancreatitis in individuals with ansa pancreatica [39]. However, no correlation was found with a single episode of acute pancreatitis.…”

Recurrent acute pancreatitis and the reverse ‘S’-shaped pancreatic duct

“…Hayashi et al in a retrospective analysis demonstrated ansa pancreatica as a predisposing factor for the onset of recurrent AP. The frequency of ansa pancreatica was highest in patients with alcoholic pancreatitis 2. The exact link between alcohol consumption and ansa pancreatica leading to recurrent AP is unknown.…”

Anatomical Patterns of the Pancreatic Ductal System – A Cadaveric and Magnetic Resonance Cholangiopancreatography Study

“…21 In the present cadaveric study, ansa pancreatica (type V) was observed in one cadaveric specimen, but not radiologically. It was reported radiologically in the MRCP (1.2%) by Adibelli et al 7 Hayashi et al 22 found that it has a significant association with recurrent acute pancreatitis.…”