title: Acute pancreatitis: pancreas divisum with ventral duct intraductal papillary mucinous neoplasms.
abstract: Acute recurrent pancreatitis occurs rarely in individuals with pancreas divisum. A 39-year-old woman with no significant history presented with pancreatitis. CT scan and MRI suggested acute on chronic pancreatitis with calcifications and pancreatic divisum. An endoscopic ultrasound demonstrated complete pancreas divisum. A large calcification measuring 12 mm × 6 mm was seen in the head of the pancreas with associated dilation of the ventral pancreatic duct. Fine-needle aspiration of the dilated ventral pancreatic duct showed an amylase level of 36,923 U/L and a carcinoembryonic antigen of 194. A ventral duct intraductal papillary mucinous neoplasm was suspected and a pancreaticoduodenectomy procedure was recommended. After the procedure, pathology demonstrated an intraductal papillary lesion in the main duct with moderate dysplasia. A pancreatic intraepithelial neoplasia, grade 2 was also present. Margins of resection were clear. This case represents the importance of assessing for secondary causes of pancreatitis in pancreas divisum.
authors.affiliation: Department of Gastroenterology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Krishna C
authors.identifier: http://orcid.org/0000-0002-0254-4648
authors.initials: KC
authors.lastname: Gurram
authors.affiliation: Departement of Pathology, Allegheny Health Network AGH, Pittsburgh, Pennsylvania, USA.
authors.forename: Agata
authors.initials: A
authors.lastname: Czapla
authors.affiliation: Department of Gastroenterology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Thakkar
mesh_terms: D000006:Abdomen, Acute; D000328:Adult; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010179:Pancreas / Q000002:abnormalities* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed