title: A giant retention cyst of the pancreas (cystic dilatation of dorsal pancreatic duct) associated with pancreas divisum.
abstract: We describe a rare case of pancreas divisum associated with a giant retention cyst (cystic dilatation of the dorsal pancreatic duct), presumably formed following obstruction of the minor papilla. The patient was treated by pancreatico(cysto)jejunostomy. A 50-year-old man was admitted with complaints of increasing upper abdominal distension and body weight loss. There was no previous history of pancreatitis, gallstones, drinking, or abdominal injury. An elastic-hard tumor-like resistance was palpable in the upper abdomen. Computed tomography and ultrasound (US) examinations revealed a giant cystic lesion expanding from the pancreas head to the tail. Endoscopic retrograde cholangiopancreatography findings showed a looping pancreatic duct which drained only the head and uncinate process of the pancreas to the main papilla. A US-guided puncture to the cystic lesion revealed that the lesion continued to the main pancreatic duct in the tail of pancreas. The lesion was connected to a small cystic lesion, which was located inside the minor papilla, and ended there. The amylase level in liquid aspirated from the cyst was 37 869 IU/l, and the result of cytological examination of the liquid showed class II. A pancreatico(cysto)jejunostomy was performed, with the diagnosis being pancreas divisum associated with a retention cyst following obstruction of the minor papilla. The histological findings of a specimen from the cyst wall revealed that the wall was a pancreatic duct covered with mildly inflammatory duct epithelium; there was no evidence of neoplasm. The patient is currently well, and a CT examination 2 years after the operation showed disappearance of the cyst and normal appearance of the whole pancreas.
authors.affiliation: Department of Surgery, Saitama Municipal Hospital, Saitama, Japan.
authors.forename: Zenichi
authors.initials: Z
authors.lastname: Morise
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamafuji
authors.forename: Tadao
authors.initials: T
authors.lastname: Tsuji
authors.forename: Atsunori
authors.initials: A
authors.lastname: Asami
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takeshima
authors.forename: Noritaka
authors.initials: N
authors.lastname: Hayashi
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
authors.forename: Fumiko
authors.initials: F
authors.lastname: Yoshida
authors.forename: Yuta
authors.initials: Y
authors.lastname: Abe
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Tokura
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010183:Pancreatic Ducts / Q000002:abnormalities*; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome