Wirsungocele as a Rare Cause of Recurrent Pancreatitis: Etiology and Therapeutic Insights

Abstract

Wirsungocele, a cystic dilation at the end of the main pancreatic duct, is associated with recurrent acute pancreatitis. A 52-year-old man presented to our hospital with recurrent epigastric pain over an 8-month period with a history of multiple medical visits for the same complaint. Endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) revealed focal cystic dilatation at the end of the main pancreatic duct; thus, he was diagnosed with Wirsungocele. He underwent endoscopic pancreatic sphincterotomy and 5Fr 4 cm pancreatic duct stent placement; the pancreatic duct stent was removed 1 month later. Magnetic resonance imaging performed 3 months after discharge revealed no cystic dilation, and he has had no recurrence of pancreatitis for at least 6 months. Dysfunction of the sphincter of Oddi, weakening of the pancreatic duct wall, inflammation and recurrent stress, elevated intraductal pressure, and genetic and structural factors are suspected mechanisms behind the pathophysiology of Wirsungocele. Although the etiology of Wirsungocele is not known, its timely identification and treatment are critical to preventing recurrent episodes of pancreatitis. This case demonstrates the diagnostic value of combining MRCP and EUS as well as the therapeutic benefits of endoscopic intervention, including sphincterotomy and stent placement, in managing Wirsungocele-associated recurrent pancreatitis. Given the paucity of reports on recurrent pancreatitis due to the Wirsungocele, we herein report this case and review the literature.

Keywords: endoscopic pancreatic sphincterotomy | magnetic resonance cholangiopancreatography | pancreatic duct stent | recurrent acute pancreatitis | wirsungocele.

FIGURE 1

Clinical course of acute pancreatitis caused by the Wirsungocele. Blood tests at 12 PM were performed 2 h after the procedure to monitor for post‐endoscopic retrograde cholangiopancreatography (post‐ERCP) pancreatitis, and the transient elevation in white blood cell count (WBC) reflects this timing. IV: intravenous drip, PO: oral administration.

FIGURE 2

(a) Magnetic resonance cholangiopancreatography (MRCP) image reveals cystic dilatation of the main pancreatic duct above the papilla. (b) Endoscopic ultrasound (EUS) image shows focal cystic dilation of the pancreatic duct with a diameter of 5.7 mm at the pancreatic head. Arrows indicate the focal cystic dilatation area.

FIGURE 3

(a) We performed endoscopic retrograde cholangiopancreatography (ERCP) on the 12th day. The duodenal papilla is mildly erythematous. (b) There is no evidence of an incomplete pancreatic duct or pancreatic divisum. (c) An endoscopic sphincterotomy knife was inserted into the duodenal papilla, and an incision was made until the outflow of pancreatic juice was confirmed. (d) A 5Fr 4 cm single pancreatic stent was inserted.