A case of pancreas divisum with marked dilatation of dorsal pancreatic duct.

Abstract

A 56-year-old man was referred to our hospital for fever and back pain. Contrast-enhanced computed tomography, magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound revealed marked dilatation of the main pancreatic duct from head to tail and surrounding cysts with no evidence of pancreatic masses or obstructive causes. Endoscopic retrograde pancreatography (ERP) from the major duodenal papilla showed a short and narrow ventral pancreatic duct and ERP from the minor duodenal papilla revealed a dilated dorsal pancreatic duct with a narrow branch which connected to the ventral pancreatic duct. Intra-ductal ultrasound showed no nodules in the main pancreatic duct, and pancreatic cytology was negative. Peroral pancreatoscopy showed that the main pancreatic duct was covered with normal epithelium without tumors. Biopsy from the pancreatic duct showed no neoplastic changes. He was diagnosed with incomplete pancreas divisum accompanied by dilatation of dorsal pancreatic duct. Sphincterotomy of the minor duodenal papilla was performed. Seven months later, MRCP re-examination showed that the main pancreatic duct dilatation was relieved. Review of the literature identified 10 cases of pancreas divisum accompanied by dilatation of main pancreatic duct to date. To our knowledge, this is the first reported case of pancreas divisum with pancreatic duct dilatation without Santorinicele.