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Meandering Main Pancreatic Duct: A Rare Cause of Idiopathic Recurrent Acute Pancreatitis
Hara Prasad Mohapatra1, Pradosh Kumar Sarangi2, Nishit Ranjan1
1General Surgery, All India Institute of Medical Sciences, Deoghar, IND.
Abstract:
The meandering main pancreatic duct (MMPD) is a rare developmental variant associated with idiopathic recurrent acute pancreatitis (IRAP) due to potential ductal hypertension. Although acute evaluation by magnetic resonance cholangiopancreatography (MRCP) is not routinely recommended for acute pancreatitis, it becomes essential in unexplained cases. We report a case of a 19-year-old male who presented with acute epigastric pain and recurrent pancreatitis, marked by elevated serum lipase and a bulky pancreas on CT. MRCP revealed an MMPD with a unique N-shape, without ductal dilatation or intraductal calcification and gallstones or other identifiable causes, suggesting it as the etiology of his IRAP. He was managed conservatively, with resolution of symptoms, and advised to avoid potential risk factors and report any recurrence. Some cases of recurrent acute pancreatitis have no identifiable cause, but anatomical variations of the pancreatic duct, such as an MMPD, are thought to play a contributory role, although the underlying mechanism is not fully understood. Early recognition of such anomalies through imaging, such as MRCP, is important to identify the underlying causes of IRAP and guide appropriate long-term management.
Insights
Meandering main pancreatic duct (MMPD) is a rare cause of idiopathic recurrent acute pancreatitis (IRAP). Early MRCP diagnosis of MMPD is crucial for managing unexplained pancreatitis.
Area of Science:
- Gastroenterology and Hepatology
- Medical Imaging
- Anatomical Pathology
Background:
- Idiopathic recurrent acute pancreatitis (IRAP) presents a diagnostic challenge, often lacking identifiable causes.
- Anatomical variations of the pancreatic duct, such as the meandering main pancreatic duct (MMPD), are implicated in IRAP pathogenesis.
- Magnetic resonance cholangiopancreatography (MRCP) is not routinely indicated for acute pancreatitis but is valuable in unexplained cases.
Observation:
- A 19-year-old male presented with recurrent acute pancreatitis and epigastric pain.
- Elevated serum lipase and pancreatic enlargement on CT were noted.
- MRCP revealed a unique N-shaped MMPD without ductal dilation or calcification, and no gallstones.
Findings:
- The identified N-shaped MMPD was considered the likely etiology of the patient's IRAP.
- Conservative management led to symptom resolution.
- No other causes for the recurrent pancreatitis were identified.
Implications:
- Early recognition of pancreatic ductal anomalies like MMPD via MRCP is vital for diagnosing IRAP.
- Identifying anatomical variants can guide long-term management strategies for patients with unexplained recurrent acute pancreatitis.
- Understanding the role of ductal variations may elucidate the mechanisms underlying IRAP.
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