Late presentation of pancreatic divisum in a 52-year-old patient with recurrent pancreatitis.
A 52-year-old male patient presented with abdominal pain. His medical history was significant of pancreatitis. In addition, 3 years ago his ultrasound was also significant cholelithiasis. Although there was no common bile dilation and cholecystitis. The findings were consistent with pancreatic divisum.
The patient’s past history was significant for alcohol use. However, he had restricted himself to 3 glasses per week since a few years. In addition, he hadn’t had any alcohol in the last 1 year. The patient’s abdominal pain was at 10/10, radiating to the back. Examination was remarkable for decreased breath sounds bilaterally. Tenderness was felt on the left upper quadrant with guarding and rigidity in absence of rebound tenderness. Chest X-ray showed left pleural effusion. In addition, CT scan showed moderate pleural effusion on the left and tiny on the right.
Doctors advised diagnostic and therapeutic thoracentesis. The fluid appeared hemorrhagic. Whereas the patient’s hematocrit remained stable. Similarly, fluid analysis was negative for acid fast bacilli and malignant cells. The tests were consistent with the diagnosis of pancreaticopleural fistula. MRCP showed intrahepatic and extrahepatic biliary duct dilation. The patient’s abdominal pain worsened. CT scan of the abdomen was suggestive of acute pancreatitis. An accessory pancreatic duct was also identified which suggested pancreas divisum. In addition, there was a collection of multiple bilateral fluid which suggested pseudocysts.
The patient was treated for an acute episode of pancreatitis. Moreover, discharged on a pancreatic enzyme supplement and a low-fat diet.
Pancreatic divisum is a common congenital variation of pancreatic duct anatomy. The condition arises when the embryological ventral and dorsal endodermal buds fail to fuse or partially fuse. Most patients are asymptomatic, however, some patients present with bouts of pancreatitis.
References
A Case of Late Presentation of Pancreatic Divisum in a Patient with Recurrent Pancreatitis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376419/
