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. 2025 May 12;9(5):e70179.
doi: 10.1002/jgh3.70179. eCollection 2025 May.

Treatment of Wirsungocele Induced Chronic Pancreatitis by Endoscopic Retrograde Cholangiopancreatography and Stent Placement: A Case Report

Nouraiz Mehmood  1 , Abdul Ahad Riaz  1 , Allahdad Khan  1 , Humaira Siddique  2 , Abdul Sattar Anjum  2 , Mohamed Antar  3
Affiliations

Treatment of Wirsungocele Induced Chronic Pancreatitis by Endoscopic Retrograde Cholangiopancreatography and Stent Placement: A Case Report

Nouraiz Mehmood et al. JGH Open. .

Abstract

Background: Wirsungocele is a rare cystic dilatation of the terminal main pancreatic duct, analogous to choledochocele and santorinicele. It has been associated with recurrent acute or chronic pancreatitis, though its pathogenesis remains unclear. Diagnostic imaging such as MRCP and ERCP plays a pivotal role, and endoscopic intervention is considered the gold standard treatment.

Case report: A 10-year-old boy presented with recurrent abdominal pain and fever since age four, diagnosed repeatedly with acute pancreatitis. Imaging via CT, MRCP, and ERCP revealed focal saccular dilation of the distal pancreatic duct consistent with Wirsungocele, along with pancreatic duct stricture and stones. The patient underwent ERCP with pancreatic sphincterotomy, extraction of cheesy material, and placement of a 5 Fr × 5 cm pancreatic duct stent. Post-procedure, the patient showed marked clinical and radiological improvement with no recurrence of symptoms at one-month follow-up.

Conclusion: This case highlights a rare pediatric presentation of Wirsungocele-induced chronic pancreatitis successfully managed with ERCP and stent placement. Early recognition and intervention can lead to significant symptomatic relief and ductal improvement. Further long-term follow-up is necessary to evaluate recurrence and guide future management.

Keywords: Wirsungocele; endoscopic retrograde cholangiopancreatography; magnetic resonance cholangiopancreatography; pancreatic duct; pancreatitis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Axial image of CT abdomen shows focal dilatation of the distal pancreatic duct at the ampullary region (long arrow) and retrograde pancreatic duct dilatation (arrowhead).
FIGURE 2
FIGURE 2
MRCP (3D coronal image) showing stricture narrowing at the ampulla, resulting in post stricture focal saccular dilatation of distal pancreatic duct (long yellow arrow) and retrograde dilatation, beaded appearance of main pancreatic duct (yellow arrow head) and shows internal signal void areas representing calculi (long white arrow).
FIGURE 3
FIGURE 3
ERCP images showing pancreatic duct stricture narrowing in the head of the pancreas at the ampulla and soft pancreatic duct stones.
See this image and copyright information in PMC

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