A difficult-to-treat case of pancreas divisum complicated by pancreatic pseudocyst

Abstract

A 45-year-old male drinker, who was hospitalized for alcohol-induced acute pancreatitis 7 years ago, recently visited us after a day-long abdominal pain and vomiting. He was hospitalized for acutely-aggravated alcohol-induced chronic pancreatitis, with increased biliary pancreatic enzyme, increased concentration of peripancreatic adipose tissue and pancreatic pseudocyst found by abdominal CT. Pancreatic enzyme decreased by conservative treatment. We performed ERCP (10th day) and diagnosed pancreas divisum with cauda equina-like Wirsung duct by major-papilla imaging. As accessory pancreatic duct imaging from minor-papilla was difficult due to excessive inflammation, we reperformed ERCP (23rd day) . ENPD was placed because cystic lesion connecting with Santolini duct was found by minor-papilla imaging. After smaller pancreatic cyst was found by CT, pancreatic duct stent was placed (31st day) , and the patient was discharged. We report a case of pancreas divisum complicated by pancreatic pseudocyst.