The Unknown Cases Texas Radiological Society 92nd Annual Scientific Meeting San Antonio, TX April 13

1
The Unknown CasesTexas Radiological Society
92nd Annual Scientific MeetingSan Antonio, TX
April 1-3, 2005

• Justin Q. Ly, MD
• Douglas P. Beall, MD
• Ernesto Torres, MD
• Daniel H. Duffy
• Department of Radiology and Nuclear Medicine
• Wilford Hall Medical Center/SAUSHEC Radiology
• Oklahoma University Health Sciences Center
• Brooke Army Medical Center

2
Patient being worked up for chronic abdominal
pain and elevated LFTs undergoes MRCP following
difficult ERCP.

• CASE 12

3
(No Transcript)
4
(No Transcript)
5
Diagnosis?

• Pancreas Divisum

6
DILATED MAIN PD DRAINING TO MINOR PAPILLA
CBD DRAINS INTO MAJOR PAPILLA
7
Discussion

• Failure of fusion dorsal (body/tail) and ventral
  (head) pancreatic buds
• Most common anatomic variant of pancreas
• 12-26 of pts with idiopathic pancreatitis
• Body and tail drained by dorsal pancreatic duct
  of Santorini via minor papilla
• Dilated, long
• Head/uncinate process drained by short ventral
  pancreatic duct of Wirsung via major papilla
• No communication between panc ducts / 2 panc
  moieties separated by fatty cleft
• Most asymptomatic but some cases can contribute
  to pancreatitis
• CT shows changes of pancreatitis
• MRCP / ERCP diagnostic

Reference Federle MP et al. Diagnostic Imaging
Abdomen. 2004. Amirsys Inc Salt Lake City, UT.