Dominant Dorsal Duct Syndrome (original) (raw)
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Clinical Journal of Gastroenterology, 2009
A 35-year-old man, a chronic alcohol consumer with clinical features of acute pancreatitis, presented with obstructive jaundice and melena. On radiological evaluation two large pseudocysts, one each in relation to pancreatic head and tail regions, were noted with a gastroduodenal artery pseudoaneurysm in the pseudocyst in the head region. He also had narrowing of the common bile duct. On endoscopic retrograde cholangiopancreatography (ERCP) he had evidence of chronic pancreatitis with morphology of pancreas divisum with disruption of both the dorsal and ventral ducts. After the relieving of bile duct obstruction with endoscopically placed stent, he underwent surgery for the pseudoaneurysm and the two pseudocysts. The case highlights the rare occurrence of both dorsal and ventral ductal disruption in a patient with pancreas divisum. ERCP was helpful in providing the diagnosis and guiding further management.
Recurrent Pancreatitis in a Preschool Child
Journal of the Pancreas, 2016
Anomalous pancreatobiliary union in association with choledochal cyst can cause recurrent pancreatitis. Anomalous pancreatobiliary union is a rare condition that can cause a diagnostic challenge and some types can cause recurrent acute pancreatitis. Here we describe a case of re-current pancreatitis with choledochal cyst and choledocholithiasis referred to our hospital for endoscopic retrograde cholangiopancreatography which lead to the incidental finding of anomalous pancreatobiliary union type IA and choledocholithiasis.
Acute pancreatitis complicated with choledochal duct rupture
2011
Recurrent acute pancreatitis is a rare clinical entity in childhood with unknown incidence and often occurring in a familial context. Genetic factors such as PRSS1 mutations (cationic trypsinogen gene) can be found in some patients. However, many remain idiopathic. The natural history remains poorly documented and the most frequent complications reported are pain, exocrine pancreatic insufficiency, diabetes mellitus, and pancreatic adenocarcinoma after long-standing hereditary pancreatitis. We describe a patient with hereditary pancreatitis in whom a mild pancreatitis episode was complicated by a perforation of the ductus choledochus.
Advances in Medical Sciences, 2008
Purpose: Pancreaticobiliary malunion (PBM) is a distinct disease entity of the pancreatic and biliary ductal system defined as a condition in which the junction of the pancreatic and biliary ducts occurs above the duodenal wall. PBM may be combined with a stenosis of the distal common bile duct and pathological changes in the common bile duct wall (congenital cyst of bile duct), being a potentially malignant condition. Pancreas divisum, resulting from a fusion failure of the ventral and dorsal pancreatic buds, and characterized by a dominant Santorine duct, is considered to be a predisposing factor to recurrent attacks of acute pancreatitis. In incomplete pancreas divisum, the ventral and dorsal pancreas are connected by a segmental branch. Material and Methods: We report a case of a 33-year-old female patient with PBM associated with incomplete pancreas divisum, who had presented episodes of acute cholangitis due to a benign distal common bile duct stricture. Results: Treatment with choledochoduodenostomy and cholecystectomy provided thorough relief and resolution of symptoms. Conclusion: This is the first report of coexistent PBM and incomplete pancreas divisum in a Caucasian patient with unusually late clinical manifestation.
Ansa pancreatica type of ductal anatomy in a patient with idiopathic acute pancreatitis
JOP : Journal of the pancreas, 2006
Ansa pancreatica is a type of pancreatic ductal variation. The exact clinical significance of this ductal variation is not clear. We report the case of a 21-year-old male with acute idiopathic severe pancreatitis and extensive parenchymal necrosis who later developed a large pancreatic abscess. Subsequently, transpapillary drainage of the pancreatic abscess was attempted and on endoscopic retrograde pancreatography, disruption in the mid-body of the pancreas and the ansa pancreatica type of ductal anatomy was noted. A 7 Fr nasopancreatic catheter was placed across the disruption. However, due to the development of a new abscess, surgical drainage was performed. The patient has since been asymptomatic over a one-year follow up period. A pancreatic ductal variation such as ansa pancreatica may be a finding in severe acute pancreatitis; it is not clear if the presence of these two conditions is co-incidental or if ansa pancreatica causes acute pancreatitis. Further studies are needed t...
Journal of the American College of Surgeons, 2009
BACKGROUND: Precepts about acute pancreatitis, necrotizing pancreatitis, and pancreatic fluid collections or pseudocyst rarely include the impact of pancreatic ductal injuries on their natural course and outcomes. We previously examined and established a system to categorize ductal changes. We sought a unifying concept that may predict course and direct therapies in these complex patients. STUDY DESIGN: We use our system categorizing ductal changes in pseudocyst of the pancreas and severe necrotizing pancreatitis (type I, normal duct; type II, duct stricture; type III, duct occlusion or "disconnected duct"; and type IV, chronic pancreatitis). From 1985 to 2006, a policy was implemented of routine imaging (cross-sectional, endoscopic retrograde cholangiopancreatography, or magnetic resonance cholangiopancreatography). Clinical outcomes were measured.
Chronic pancreatitis with acute obstructive suppurative pancreatic ductitis: a rare case report
Acute obstructive suppurative pancreatic ductitis (AOSPD) is a rare complication of chronic pancreatitis that has been described in only seven previous case reports since 1995. We report a case of a 33-year-old female a known case of chronic pancreatitis with computed tomography suggestive of dilated main pancreatic duct with multiple calcifications. On exploration, pancreatic duct aspiration revealed frank pus. Pus was drained after opening the pancreatic duct and longitudinal pancreaticojejunostomy was done. Patient was relieved of her symptoms after surgery. In conclusion, AOSPD should be considered in long standing cases of chronic pancreatitis. AOSPD appears to respond quickly after drainage procedure like longitudinal pancreaticojejunostomy and should be considered the treatment of choice.