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Meandering Main Pancreatic Duct in Association with Choledochal Cysts and Acute Pancreatitis in Pediatrics

Arvind V Panchoo, Juan C Infante, Edgardo D Rivera Rivera

    Pediatric Annals
    |October 15, 2019
    PubMed

    Insights

    Meandering main pancreatic duct (MMPD), an uncommon anomaly, is linked to recurrent acute pancreatitis in children. This report details two pediatric cases, including the first association of MMPD with choledochal cysts.

    Area of Science:

    • Gastroenterology
    • Pediatric Surgery
    • Medical Imaging

    Background:

    • Meandering main pancreatic duct (MMPD) is a rare pancreatic duct anomaly.
    • Its clinical significance, especially in pediatric recurrent acute pancreatitis, is not well-established.
    • Magnetic resonance cholangiopancreatography (MRCP) is key for diagnosing MMPD.

    Observation:

    • Two pediatric cases of recurrent acute pancreatitis associated with MMPD are presented.
    • Case 1: A 15-year-old girl with idiopathic acute pancreatitis and diagnosed MMPD.
    • Case 2: A 5-year-old boy with his second acute pancreatitis episode, showing MMPD and a type IVA choledochal cyst.

    Findings:

    • MMPD was diagnosed in both pediatric patients presenting with recurrent acute pancreatitis.
    • This study reports the first known association between MMPD and choledochal cysts.
    • Both patients showed clinical improvement and symptom resolution with management.

    Implications:

    • MMPD should be considered in the differential diagnosis for pediatric recurrent acute pancreatitis.
    • The findings suggest a potential link between MMPD and recurrent pancreatitis in children.
    • This report expands understanding of pancreatic duct anomalies and their pediatric manifestations.

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