Pancreatitis in patients with pancreas divisum: Imaging features at MRI and MRCP

Wang, Dengbin; Yu, Jiahui; Fulcher, Ann S.; Turner, Mary Ann

doi:10.3748/wjg.v19.i30.4907

Cited by 37 publications

(27 citation statements)

References 25 publications

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“…Extensive intraand interlobular fibrosis with periductal fibrosis can be seen on microscopy. Inflammatory cell infiltrate is sparse in advanced stages [5].…”

Section: Discussionmentioning

confidence: 99%

“…The exact etiopathogenesis is still unclear, the hypothesis proposed are malnutrition, toxins, cassava consumption (cyanogen toxicity), familial and genetic factors (SPINK1-serine protease inhibitor kazal Type 1 gene), oxidative stress, anti oxidant depletion, free radical injury and trace element deficiency [4]. There is irreversible destruction and fibrosis of both exocrine and endocrine pancreas leading to ductal strictures with dilatation, stasis resulting in atrophy of pancreas, calcification and calculi formation [5].…”

Section: Discussionmentioning

confidence: 99%

“…TCP is characterized by young age of onset, extensive pancreatic calcifications, formation of large calculi in the pancreatic duct and high risk of pancreatic cancer [5]. When diabetes is associated with TCP, it is called Fibrocalculous Pancreatic Diabetes (FCPD) [4].…”

Section: Discussionmentioning

confidence: 99%

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A Case of Chronic Abdominal Pain

Ranga

2013

JCDR

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A 26-year-old non-smoker, non-alcoholic, male was admitted for the evaluation of chronic abdominal pain which had been persistent for more than six months. He took treatment from different centres, but the pain-relief was only partial. He gave history of passing frequent, foul-smelling stools with Loss of appetite and weight. He had polyuria, there was no polyphagia or polydypsia. He never had cough or fever or vomiting or bleeding per rectum. There was no past or family history of diabetes mellitus or pulmonary tuberculosis.General and clinical examination of cardiovascular system, respiratory system, abdomen, and central nervous system were unremarkable. Complete haemogram, renal and liver function, lipid and thyroid profile, urine and stool examination, electrolytes, calcium and phosphate were normal. Urine for albumin, ketone and Porphyrins were negative. HBsAg, Anti-HCV, Anti-HIV were also negative. ECG and chest X-ray were within normal limits. Fasting blood sugar was 278mg%, post-prandial blood sugar was 486 mg%, and HbAIC was 10.1%. Serum amylase and lipase were slightly elevated which returned to normal after treatment.

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“…Extensive intraand interlobular fibrosis with periductal fibrosis can be seen on microscopy. Inflammatory cell infiltrate is sparse in advanced stages [5].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Case of Chronic Abdominal Pain

Ranga

2013

JCDR

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“…While in type 3 (incomplete PD), there is a filamentous or tiny caliber communication between the dominant dorsal duct of Wirsung and duct of Santorini [3] (Figure2). In the western countries, the incomplete PD is uncommon with a reported incidence of 0.13%-0.9% [4]. However recent reports from Japan and Korea show a much higher prevalence of 48% to 52%, of incomplete PD [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…In the western countries, the incomplete PD is uncommon with a reported incidence of 0.13%-0.9% [4]. However recent reports from Japan and Korea show a much higher prevalence of 48% to 52%, of incomplete PD [4,5]. In patients with a large duct, the majority of the pancreatic secretions (up to 2000 ml daily) pass through the minor papilla (instead of major) resulting in inadequate drainage and pain caused by obstruction [2].…”

Section: Introductionmentioning

confidence: 99%

Pancreatic Divisum: Beyond what is Obvious

2014

Pancreat Disord Ther

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In over 90% of healthy people, the dorsal and ventral endodermal pancreatic buds fuse to form the adult pancreas. However, in about the remaining 10% of the population where the fusion does not occur, pancreatic divisum (PD) results. This indeed is the commonest congenital anomaly of pancreas. The dorsal root usually drains a part of pancreatic head, the body and tail of the pancreas via a minor papilla into the duodenum. The ventral root drains the uncinate process and part of the pancreatic head with the CBD via the major papilla into the duodenum and the two roots are communicated with one another. In classic PD (type1) there is a complete failure of fusion of ducts, and a small ventral duct (Santorini) drains through the larger major papilla, and a larger dorsal duct (Wirsung) drains through the smaller minor papilla. In type 2, there is a complete absence of duct of Wirsung. While in type (incomplete PD), there is a filamentous or tiny caliber communication between the dominant dorsal duct of Wirsung and duct of Santorini. In the western countries, the incomplete PD is uncommon with a reported incidence of 0.13%-0.9%. However recent reports from Japan and Korea show a much higher prevalence of 48% to 52%, of incomplete PD. In patients with a large duct, the majority of the pancreatic secretions pass through the minor papilla (instead of major) resulting in inadequate drainage and pain caused by obstruction. However while these features of PD are relatively well known, there are some aspects of PD, which are not so obvious. These include its true prevalence, its role in development of pancreatitis and carcinoma of pancreas, the genetic abnormalities and its association with pancreatitis in presence of PD and the appropriate management of these patients when symptomatic

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Pancreas divisum in a young patient with chronic abdominal pain as per radiological findings: A case report

Kayastha

Pokhrel

Bhatta

et al. 2023

Clinical Case Reports

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Key Clinical MessagePancreas divisum (PD) can be one of the causes of unexplained chronic abdominal pain. In PD, the dominant duct drains the majority of the pancreas via the minor papilla, which can be conveyed in the imaging as crossing duct sign.AbstractWe report a case a of 16‐year‐old man who presented with unexplained chronic abdominal pain. Contrast‐enhanced computed tomography and magnetic resonance cholangiopancreatography showed a bulky pancreas, but his pancreatic enzymes were normal. The crossing duct sign was prominent in imaging, which confirmed the diagnosis of PD.

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Pancreatitis in patients with pancreas divisum: Imaging features at MRI and MRCP

Abstract: MRCP and MRI can depict the features of pancreatitis associated with divisum. Recurrent acute pancreatitis and isolated dorsal involvement are more common in patients with divisum.

Cited by 37 publications

References 25 publications

A Case of Chronic Abdominal Pain

A Case of Chronic Abdominal Pain

Pancreatic Divisum: Beyond what is Obvious

Pancreas divisum in a young patient with chronic abdominal pain as per radiological findings: A case report

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