Pancreas divisum and duodenal diverticula as two causes of acute or chronic pancreatitis that should not be overlooked: a case report
Pancreas divisum and duodenal diverticula as two causes of acute or chronic pancreatitis that should not be overlooked: a case report
Journal of Medical Case Reports 2008, 2:166
Published: December 2009
Published: December 2009
Abstract
Introduction:
Pancreas divisum is a congenital anatomical anomaly characterized by the lack of fusion of the ventral and dorsal parts of the pancreas during the eighth week of fetal development. This condition is found in 5% to 14% of the general population. In pancreas divisum, the increased incidence of acute and chronic pancreatitis is caused by inadequate drainage of secretions from the body, tail and part of the pancreatic head through an orifice that is too small. The incidence of diverticula in the second part of the duodenum is found in approximately 20% of the population. Compression of the duodenal diverticula at the end of the common bile duct leads to the formation of biliary lithiasis (a principal cause of acute pancreatitis), pain associated with biliary lithiasis owing to compression of the common bile duct (at times with jaundice), and compression of the last part of Wirsung's duct or the hepatopancreatic ampulla (ampulla of Vater) that may lead to both acute and chronic pancreatitis.
Case presentation:
We describe the radiological findings of the case of a 75-year-old man with recurrent acute pancreatitis due to a combination of pancreas divisum and duodenal diverticula.
Conclusion:
Magnetic resonance cholangiopancreatography is advisable in patients with recurrent pancreatitis (both acute and chronic) since it is the most appropriate noninvasive treatment for the study of the pancreatic system (and the eventual presence of pancreas divisum) and the biliary systems (eventual presence of biliary microlithiasis). Moreover, it can lead to the diagnostic suspicion of duodenal diverticula, which can be confirmed through duodenography with X-ray or computed tomography scan with a radio-opaque contrast agent administered orally.
Introduction
In the absence of biliary lithiasis or alcohol abuse, pancreas divisum (PD) can be hypothesized as the cause of recurrent or chronic pancreatitis, which may be confirmed through magnetic resonance cholangiopancreatography (MRCP).
Another cause of recurrent or chronic pancreatitis is a diverticulum of the second part of the duodenum. This condition is rarely taken into consideration; when it is small (generally duodenal diverticula (DD) are only a few millimeters in size), it is often missed by radiologists using computed tomography (CT) or magnetic resonance imaging.
A study of the literature showed that there is a surprisingly high incidence of DD in the general population (around 20%). We have only rarely found DD during routine CT and MRCP, and only when they are larger than 3 to 4 cm [1].
A precise etiological diagnosis is fundamental for the treatment of recurrent or chronic pancreatitis: PD and diverticula of the second part of the duodenum are treated in two different ways, the first with endoscopic sphincterotomy of the hepatopancreatic ampulla, the second with surgical removal.
We describe the case of an elderly man with recurrent chronic pancreatitis due to a combination of PD and duodenal diverticulum.
Keywords:
Pancreas divisum, duodenal diverticula, acute pancreatitis, chronic pancreatitis, pancreas divisum, CT, MRI, cholangiopancreatography,
Pancreas divisum, duodenal diverticula, acute pancreatitis, chronic pancreatitis, pancreas divisum, CT, MRI, cholangiopancreatography,
References:
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- Lehman GA: Acute recurrent pancreatitis. Can J Gastroenterol 2003, 17:381-383.
