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The course of traumatic pancreatitis in a patient with pancreas divisum: a case report.

Chryssou EG, Prassopoulos P, Mouzas J, Maris TG, Gourtsoyiannis N - BMC Gastroenterol (2003)

Bottom Line: In the presented case, PD influenced the evolution of lesions after pancreatic trauma.A 38 years old patient refferred to our hospital with recurrent episodes of mild pancreatitis during the last two years.The first episode occurred four months after blunt abdominal trauma.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, University Hospital of Heraklion, 71110 Stavrakia, Voutes, Greece. gellych@hotmail.com

ABSTRACT

Background: The peculiar anatomy of pancreatic ducts in pancreas divisum (PD) may interfere with the development of acute chronic pancreatitis. In the presented case, PD influenced the evolution of lesions after pancreatic trauma.

Case presentation: A 38 years old patient refferred to our hospital with recurrent episodes of mild pancreatitis during the last two years. The first episode occurred four months after blunt abdominal trauma. Endoscopic Retrograde Cholangiopancreatography, Magnetic Resonance Imaging of upper abdomen and Magnetic Resonance Cholangiopancreatography disclosed pancreas divisum, changes consistent with chronic pancreatitis in the dorsal pancreatic duct, atrophy in the body and tail of the pancreas and a pseudocyst in the pancreatic head, that was drained endoscopically.

Conclusion: Pancreas Divisum may interfere with the evolution of posttraumatic changes in the pancreas after blunt abdominal trauma.

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Title: Spoiled gradient echo fat suppressed T1-weighted sequence Axial section at the level of the pancreas, demonstrating significant atrophy of the pancreatic body and tail.
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Figure 2: Title: Spoiled gradient echo fat suppressed T1-weighted sequence Axial section at the level of the pancreas, demonstrating significant atrophy of the pancreatic body and tail.

Mentions: A 38 years old male was admitted to hospital with an acute episode of mild abdominal pain with raised levels of serum and urine amylase. The calcium level was within normal limits (8.9 mg/dl). He had a history of 8 episodes of mild acute pancreatitis during the last 5 years, that were introduced four months after severe blunt abdominal trauma. An ultrasonographic examination, disclosed a cystic lesion at the head of the pancreas. Consequently, the patient was referred for endoscopic retrograde cholangiopancreatography (ERCP). Cannulation of the major papilla revealed a short pancreatic duct branching off regularly, without continuation along the body and tail of the pancreas (fig. 1), suggesting a pancreas divisum. The minor papilla could not be cannulated and thus the dorsal duct was not depicted. The patient underwent Magnetic Resonance Imaging (MRI) of upper abdomen and Magnetic Resonance Cholangiopancreatography (MRCP). MRI demonstrated significant atrophy of the body and tail of the pancreas (fig. 2). A small, clearly demarcated cystic lesion was demonstrated in the pancreatic head, in close proximity to the duodenal bulb (fig. 3). MRCP revealed a dilated and irregularly beaded dorsal pancreatic duct with side branch ectasia in the body and tail of the pancreas (fig. 4). A short stenotic segment of the duct was demonstrated at the pancreatic neck. The cystic lesion in the pancreatic head was in continuation with this stenotic segment of the pancreatic duct. The duct was shown draining in the duodenum 1–2 cm superiorly to the draining point of the common bile duct (CBD). The CBD drained in conjunction with the short ventral pancreatic duct at the major papilla. Diagnosis based on ERCP and MRCP findings was pancreatic ductal stenosis, pseudocyst and chronic pancreatitis of the portion drained by the dorsal duct in a pancreas divisum. Internal drainage of the cyst was decided. An upper gastrointestinal endoscopy was performed and a cutting was undertaken by means of a needle knife at the point of a major bulging in the duodenal bulb. A 10 French 5 cm long pig-tail stent was introduced, thus securing the internal drainage of the cyst. Biochemical tests of cystic fluid were consistent with a pseudocyst. The pig-tail stent was extracted after one month. Following the drainage of the pseudocyst, the patient experienced complete remission of the episodes of recurrent pancreatitis for a two years period follow-up, but he is still, infrequently, complaining of mild upper abdominal pain. Imaging evaluation during follow-up confirmed elimination of the pseudocyst, but the patient is still under clinical follow-up.


The course of traumatic pancreatitis in a patient with pancreas divisum: a case report.

Chryssou EG, Prassopoulos P, Mouzas J, Maris TG, Gourtsoyiannis N - BMC Gastroenterol (2003)

Title: Spoiled gradient echo fat suppressed T1-weighted sequence Axial section at the level of the pancreas, demonstrating significant atrophy of the pancreatic body and tail.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC153522&req=5

Figure 2: Title: Spoiled gradient echo fat suppressed T1-weighted sequence Axial section at the level of the pancreas, demonstrating significant atrophy of the pancreatic body and tail.
Mentions: A 38 years old male was admitted to hospital with an acute episode of mild abdominal pain with raised levels of serum and urine amylase. The calcium level was within normal limits (8.9 mg/dl). He had a history of 8 episodes of mild acute pancreatitis during the last 5 years, that were introduced four months after severe blunt abdominal trauma. An ultrasonographic examination, disclosed a cystic lesion at the head of the pancreas. Consequently, the patient was referred for endoscopic retrograde cholangiopancreatography (ERCP). Cannulation of the major papilla revealed a short pancreatic duct branching off regularly, without continuation along the body and tail of the pancreas (fig. 1), suggesting a pancreas divisum. The minor papilla could not be cannulated and thus the dorsal duct was not depicted. The patient underwent Magnetic Resonance Imaging (MRI) of upper abdomen and Magnetic Resonance Cholangiopancreatography (MRCP). MRI demonstrated significant atrophy of the body and tail of the pancreas (fig. 2). A small, clearly demarcated cystic lesion was demonstrated in the pancreatic head, in close proximity to the duodenal bulb (fig. 3). MRCP revealed a dilated and irregularly beaded dorsal pancreatic duct with side branch ectasia in the body and tail of the pancreas (fig. 4). A short stenotic segment of the duct was demonstrated at the pancreatic neck. The cystic lesion in the pancreatic head was in continuation with this stenotic segment of the pancreatic duct. The duct was shown draining in the duodenum 1–2 cm superiorly to the draining point of the common bile duct (CBD). The CBD drained in conjunction with the short ventral pancreatic duct at the major papilla. Diagnosis based on ERCP and MRCP findings was pancreatic ductal stenosis, pseudocyst and chronic pancreatitis of the portion drained by the dorsal duct in a pancreas divisum. Internal drainage of the cyst was decided. An upper gastrointestinal endoscopy was performed and a cutting was undertaken by means of a needle knife at the point of a major bulging in the duodenal bulb. A 10 French 5 cm long pig-tail stent was introduced, thus securing the internal drainage of the cyst. Biochemical tests of cystic fluid were consistent with a pseudocyst. The pig-tail stent was extracted after one month. Following the drainage of the pseudocyst, the patient experienced complete remission of the episodes of recurrent pancreatitis for a two years period follow-up, but he is still, infrequently, complaining of mild upper abdominal pain. Imaging evaluation during follow-up confirmed elimination of the pseudocyst, but the patient is still under clinical follow-up.

Bottom Line: In the presented case, PD influenced the evolution of lesions after pancreatic trauma.A 38 years old patient refferred to our hospital with recurrent episodes of mild pancreatitis during the last two years.The first episode occurred four months after blunt abdominal trauma.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, University Hospital of Heraklion, 71110 Stavrakia, Voutes, Greece. gellych@hotmail.com

ABSTRACT

Background: The peculiar anatomy of pancreatic ducts in pancreas divisum (PD) may interfere with the development of acute chronic pancreatitis. In the presented case, PD influenced the evolution of lesions after pancreatic trauma.

Case presentation: A 38 years old patient refferred to our hospital with recurrent episodes of mild pancreatitis during the last two years. The first episode occurred four months after blunt abdominal trauma. Endoscopic Retrograde Cholangiopancreatography, Magnetic Resonance Imaging of upper abdomen and Magnetic Resonance Cholangiopancreatography disclosed pancreas divisum, changes consistent with chronic pancreatitis in the dorsal pancreatic duct, atrophy in the body and tail of the pancreas and a pseudocyst in the pancreatic head, that was drained endoscopically.

Conclusion: Pancreas Divisum may interfere with the evolution of posttraumatic changes in the pancreas after blunt abdominal trauma.

Show MeSH
Related in: MedlinePlus