Ansa Pancreatica-Type Anatomic Variation of the Pancreatic Duct in Patients with Recurrent Acute Pancreatitis and Chronic Localized Pancreatitis (original) (raw)
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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...
Ansa pancreatica: a rare cause of acute recurrent episode in chronic pancreatitis
2021
Ansa pancreatica is a rare anatomic variation of pancreatic ducts. It is a predisposing factor of recurrent pancreatitis. In this case report, we describe a case of a 24-year-old male suffering from an ansa pancreatica with a non-patent major papilla, diagnosed on magnetic resonance cholangiopancreatography (MRCP).The ansa pancreatica was revealed by an episode of acute pancreatitis attacks in chronic pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed important abrupt dilation in the main pancreatic duct with an ansa loop in the pancreatic duct in the head of the pancreas, and a sphincterotomy of the minor papilla was performed. The procedure was difficult and the placement of a long-term pancreatic stent during the ERCP was impossible, thus a surgical pancreatico-jejunostomy was proposed as a treatment of an ansa pancreatica with a non-patent major papilla.
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.
Scandinavian Journal of Gastroenterology, 2020
Background: Except for pancreas divisum (PD), the prevalence of anatomic variants of the main pancreatic duct (MPD) seems to be insufficiently investigated. To date, their role in the occurrence of pancreatic exocrine insufficiency (PEI) and morphological changes suggestive of chronic pancreatitis (CP) has remained unclear. Methods: A systematic review was performed, searching MEDLINE and Web of Science, limited to articles published between 1960 and 1 June 2019. Results: Our review included a total number of 3234 subjects. The most common variant of MPD was type 3, followed by type 1, indicating MPD drainage pattern into major papilla (MP) as the most frequent. A sub-variant of type 3, known as 'reverse pancreas divisum' had a prevalence of 2.2%. Type 4 variant-PD, was found in 6.4% of all cases. The most common sub-variant of PD was complete PD, followed by incomplete PD and variant with MPD as only pancreatic duct. Type 5 variant (including ansa pancreatica) was present in 2.9% of subjects. Apart from one study with a significantly higher frequency of morphological changes suggestive of CP in patients with ansa pancreatica, the studies stated no significant association between pancreatic disease and MPD variants. Furthermore, only one study examined the influence of MPD variants on exocrine pancreatic function. Although equivocal, this association is most likely found to be insignificant. Conclusion: To elucidate linkage between MPD variants and the occurrence of chronic pancreatitis and impairment of pancreatic exocrine function, further clinical investigations are warranted.
Annals of Anatomy - Anatomischer Anzeiger, 1996
Analysis of 97 human postmortem pancreatograms and 103 endoscopic pancreatograms revealed a total of 3 cases (1.5070) with isolated variants in the branches of the main pancreatic duct. In the first one, tortuous branches were present in the upper head-body region. The second case involved joint tributaries bridging over an unstenosed segment of the main pancreatic duct. In the third case, we found three branches from the uncinate process running down to the main duct. In all of these cases no pathological substrate was found, and they should be considered as anatomical variants observed during interpretation of a radiogram.