23 - Pancreatic Duct Anomalies and Its Clinical Implications in Recurrent Acute Pancreatitis

Poster Board Number: 23
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Abstract Body : Background: Understanding the anatomy of the extrahepatic biliary tract, its formation, and aberrations is crucial for treating pancreatic diseases. Ansa Pancreatica, a rare variation in pancreatic duct anatomy acts as a trigger for recurrent acute pancreatitis (RAP). Despite advances in diagnostic modalities such as MRCP and endoscopic ultrasonography, more than one-fourth of the cases remain undetected.We report a case of recurrent acute pancreatitis in a Indian woman with ansa pancreatica based on radiology and clinical diagnosis. We discuss the embryological ductal variants with illustrations that could have triggered RAP and may be of clinical aid to physicians and surgeons while planning the management of these cases.
Material methods: Embryological illustrations were created to correlate with the radiological image to depict the different patterns of ductal anomalies.
Results: The illustrations depict the main pancreatic duct is formed by the anastomosis of the distal two-thirds of the dorsal pancreatic duct(DPD) and the entire ventral pancreatic duct(VPD). RAP arises when the proximal part of DPD which forms the accessory pancreatic duct obliterates and a side duct branches from the main pancreatic duct and loops in a “S” shaped manner as seen on magnetic resonance cholangiopancreaticography (MRCP), hampering the flow of pancreatic juice causing RAP. An endoscopic retrograde cholangiopancreatography (ERCP) confirmed MRCP findings and a sphincterotomy was done as a therapeutic measure. The patient is currently under follow-up and is in good health with no further complications.
Conclusions: Ansa pancreatica is, a rare anatomical variant of pancreas that can present as recurrent acute pancreatitis and needs to be evaluated during the etiological work-up of patients presenting with recurrent pancreatitis, especially while considering ductal anomalies. An awareness of these anomalies helps in surgical planning which could improve the quality of life (QOL) and Disability Adjusted Life Years (DALYs).