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

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...

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Published inProgress of Digestive Endoscopy Vol. 92; no. 1; pp. 166 - 167
Main Authors Watanabe, Koji, Yoshimoto, Kensuke, Yamada, Yuto, Kimura, Yusuke, Iwasaki, Susumu, Kishimoto, Yui, Ito, Ken, Okano, Naoki, Igarashi, Yoshinori
Format Journal Article
LanguageJapanese
English
Published Japan Gastroenterological Endoscopy Society Kanto Chapter 15.06.2018
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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.
AbstractList 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.
Author Yoshimoto, Kensuke
Ito, Ken
Iwasaki, Susumu
Yamada, Yuto
Kimura, Yusuke
Watanabe, Koji
Okano, Naoki
Kishimoto, Yui
Igarashi, Yoshinori
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  organization: Department of Gastroenterology and Hepatology, Toho University Medical Center Omori Hospital
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References 1) 濱野徹也，西野隆義，菅　元泰，他 : Pancreas Divisumに対する内視鏡治療．胆と膵 38 : 205-211，2017
3) 上田　樹，菊山正隆，黒上貴史，他 : 膵炎を繰り返す膵管非癒合に対して膵管ステント留置後に重症膵炎を発祥し，経鼻膵管ドレナージで治療しえた1例．膵臓 29 : 105-111，2014
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