Choledochal Cyst and Pancreas Divisum: A Case Report

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pediatric Surgery

Background:

• Choledochal cysts (CC) are biliary tree anomalies, while pancreas divisum (PD) is a rare congenital pancreatic duct fusion anomaly.
• The co-occurrence of CC and PD is uncommon and poses significant management challenges.
• This report details the case of a young woman with this combined anomaly.

Observation:

• A 23-year-old woman presented with severe abdominal pain and pancreatitis.
• Imaging revealed a choledochal cyst, and ERCP confirmed concomitant pancreas divisum.
• She underwent pancreaticoduodenectomy, followed by numerous hospitalizations for recurrent pancreatitis over 9 years.

Findings:

• Pancreaticoduodenectomy is a surgical option for combined choledochal cyst and pancreas divisum.
• This specific case highlights the potential for unfavorable outcomes and recurrent pancreatitis post-pancreaticoduodenectomy.
• The association between CC and PD warrants suspicion in patients with unexplained recurrent pancreatitis or cholangitis.

Implications:

• The findings suggest that pancreaticoduodenectomy may not be the optimal surgical approach for choledochal cyst with pancreas divisum.
• Less extensive surgical interventions might yield better outcomes for patients with this rare combined anomaly.
• Clinicians should consider this association when evaluating patients with recurrent pancreatitis and biliary anomalies.