Answer for BIR CoW 29 Mar 2026
Chronic calcific pancreatitis with Pancreatic divisum Type I
Findings
Atrophic pancreatic parenchyma noted. Dorsal pancreatic duct appears grossly dilated ~ measuring 11 mm seen entering the duodenum with multiple T2 hypointense intraductal calculus largest measuring ~ 8.5 x 4.6 mm. Ventral pancreatic duct also appears dilated with maximum diameter of 1.6 cm and noted joining with distal CBD before draining into duodenum No communication between ventral and dorsal pancreatic duct
Discussion
Pancreas divisum is the most common anatomic variant of the pancreas In Pancreatic divisum, there is failure of the fusion of dorsal and ventral pancreatic buds, which typically should occur at the 6th–8th week of gestation. The duct of Wirsung (duct of the ventral bud) drains only the head of the pancreas via the major papilla, while the duct of Santorini (duct of the dorsal bud) drains the majority of the pancreas, namely body and tail via the more cranially and anteriorly positioned minor papilla. Although most patients with PD are asymptomatic, PD may be the cause of chronic abdominal pain, acute, and recurrent pancreatitis. The major dominant dorsal pancreatic duct drains into the relatively smaller or stenotic minor papilla, which causes inadequate drainage of pancreatic secretions and transient obstruction of flow. This cause an increase in intraductal pressure and distention of the dorsal duct, which may lead to abdominal pain and pancreatitis. Another clinically relevant issue with pancreas divisum is that at ERCP only the ventral duct can be cannulated through the major papilla, and a small ventral duct may be misdiagnosed as an obstructed pancreatic duct. On MRCP images, pancreas divisum can be diagnosed by the finding of dorsal dominant pancreatic duct running anteriorly to the CBD and draining into the minor papilla. Treatment options: Conservative management ,Minor papilla sphincterotomy ,Dorsal duct stenting ,Balloon dilatation of minor papilla ,Minor papilla sphincteroplasty,Pancreaticojejunostomy (Puestow procedure) ,Partial pancreatectomy ,EUS-guided pancreatic duct drainage In our case,the patient was proceeded with lateral pancreaticojejunostomy.
Findings
Atrophic pancreatic parenchyma noted. Dorsal pancreatic duct appears grossly dilated ~ measuring 11 mm seen entering the duodenum with multiple T2 hypointense intraductal calculus largest measuring ~ 8.5 x 4.6 mm. Ventral pancreatic duct also appears dilated with maximum diameter of 1.6 cm and noted joining with distal CBD before draining into duodenum No communication between ventral and dorsal pancreatic duct
Discussion
Pancreas divisum is the most common anatomic variant of the pancreas In Pancreatic divisum, there is failure of the fusion of dorsal and ventral pancreatic buds, which typically should occur at the 6th–8th week of gestation. The duct of Wirsung (duct of the ventral bud) drains only the head of the pancreas via the major papilla, while the duct of Santorini (duct of the dorsal bud) drains the majority of the pancreas, namely body and tail via the more cranially and anteriorly positioned minor papilla. Although most patients with PD are asymptomatic, PD may be the cause of chronic abdominal pain, acute, and recurrent pancreatitis. The major dominant dorsal pancreatic duct drains into the relatively smaller or stenotic minor papilla, which causes inadequate drainage of pancreatic secretions and transient obstruction of flow. This cause an increase in intraductal pressure and distention of the dorsal duct, which may lead to abdominal pain and pancreatitis. Another clinically relevant issue with pancreas divisum is that at ERCP only the ventral duct can be cannulated through the major papilla, and a small ventral duct may be misdiagnosed as an obstructed pancreatic duct. On MRCP images, pancreas divisum can be diagnosed by the finding of dorsal dominant pancreatic duct running anteriorly to the CBD and draining into the minor papilla. Treatment options: Conservative management ,Minor papilla sphincterotomy ,Dorsal duct stenting ,Balloon dilatation of minor papilla ,Minor papilla sphincteroplasty,Pancreaticojejunostomy (Puestow procedure) ,Partial pancreatectomy ,EUS-guided pancreatic duct drainage In our case,the patient was proceeded with lateral pancreaticojejunostomy.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
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We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!