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Case Reports
. 2022 Sep 13:82:104642.
doi: 10.1016/j.amsu.2022.104642. eCollection 2022 Oct.

Acute recurrent pancreatitis in a child with pancreatic divisum- A case report

Ojas Thapa  1 , Sunil Basukala  2 , Manju Shrestha  3 , Yugant Khand  1 , Soumya Pahari  1 , Sujan Bohara  4 , Anup Thapa  2 , Aashish Shah  5
Affiliations
Case Reports

Acute recurrent pancreatitis in a child with pancreatic divisum- A case report

Ojas Thapa et al. Ann Med Surg (Lond). .

Abstract

Introduction and importance: In children, acute recurrent pancreatitis is attributed to pancreato-biliary anomalies, hereditary pancreatitis and cystic fibrosis. Pancreatic divisum is a common congenital ductal anomaly that leads to recurrence of pancreatitis.

Case presentation: A 13 years old female presented with clinical features of acute recurrent pancreatitis. After ruling out common causes, magnetic resonance cholangiopancreatography was done which showed pancreatic divisum. Her symptoms resolved following duodenum preserving pancreatic head resection.

Discussion: Acute recurrent pancreatitis is attributed to raised intrapancreatic dorsal ductal pressure due to ductal anomalies especially pancreatic divisum (PD). It is the embryological failure in the fusion of the dorsal and ventral ductal system. PD is further classified into a classical subtype where there is complete failure of ductal fusion and an incomplete subtype where there is partial fusion of the ductal system. The diagnosis is commonly done through abdominal imaging with secretin enhanced magnetic resonance cholangiopancreatography being the choice of imaging modality. The initial approach is endoscopic intervention unless patients present with signs of pancreatic fibrosis where a duodenum preserving pancreatic head resection can be carried out.

Conclusion: A keen suspicion should be given towards anatomical or structural variants in absence of common etiologies. Early identification and management of pancreatic divisum prevents the recurrence of pancreatitis.

Keywords: Acute recurrent pancreatitis; Case report; MRCP; Pancreatic divisum.

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Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Magnetic resonance cholangiopancreatography (MRCP) of the abdomen showing pancreas divisum (A) Common Bile Duct (CBD) which drains into duodenum via major papilla (red arrow). (B) dorsal pancreatic duct which drains directly into duodenum via minor papilla (which is the most prominent duct in pancreatic divisum) (yellow arrow). . (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
See this image and copyright information in PMC

References

    1. Banks P.A., Freeman M.L., Practice Parameters Committee of the American College of Gastroenterology Practice guidelines in acute pancreatitis. Am. J. Gastroenterol. 2006;101(10):2379–2400. doi: 10.1111/j.1572-0241.2006.00856.x. - DOI - PubMed
    1. Braganza J.M., Lee S.H., McCloy R.F., McMahon M.J. Chronic pancreatitis. Lancet (London, England) 2011;377(9772):1184–1197. doi: 10.1016/S0140-6736(10)61852-1. - DOI - PubMed
    1. Gariepy C.E., Heyman M.B., Lowe M.E., Pohl J.F., Werlin S.L., Wilschanski M., Barth B., Fishman D.S., Freedman S.D., Giefer M.J., Gonska T., Himes R., Husain S.Z., Morinville V.D., Ooi C.Y., Schwarzenberg S.J., Troendle D.M., Yen E., Uc A. Causal evaluation of acute recurrent and chronic pancreatitis in children: consensus from the INSPPIRE group. J. Pediatr. Gastroenterol. Nutr. 2017;64(1):95–103. doi: 10.1097/MPG.0000000000001446. - DOI - PMC - PubMed
    1. Somogyi L., Martin S.P., Venkatesan T., Ulrich C.D., II Recurrent acute pancreatitis: an algorithmic approach to identification and elimination of inciting factors. Gastroenterology. 2001 Feb 1;120(3):708–717. - PubMed
    1. Lehman G.A. Acute recurrent pancreatitis. Canadian journal of gastroenterology = Journal canadien de gastroenterologie. 2003;17(6):381–383. doi: 10.1155/2003/781237. - DOI - PubMed

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