Aimen Farooq, MD, Baha Aldeen Bani Fawwaz, MD, Rima Shobar, MD, MS, Abu Hurairah, MD Florida Hospital, Orlando, FL
Introduction: Acute pancreatitis (AP) is a common cause of gastrointestinal hospitalizations resulting in significant healthcare burden. Variation in pancreatic duct anatomy is an uncommon cause of acute pancreatitis. Ansa pancreatica is a rare anatomic variant where the duct of Santorini (accessory duct) either forms an S-shape en route to the duct of Wirsung (main pancreatic duct) or a looping branch within the duct of Wirsung is seen as it joins the accessory duct, resulting in inadequate drainage. We present a case of ansa pancreatica resulting in acute pancreatitis.
Case Description/Methods: A 47-year-old female with history of type 2 diabetes, cholecystitis status post cholecystectomy and one previous episode of acute pancreatitis without an obvious cause, presented to the hospital with nausea and epigastric pain radiating to the back. Patient was afebrile on exam with mild epigastric tenderness. Labs were significant for elevated lipase 386 U/L. Metabolic workup, alcohol level and triglycerides were all within normal limits. There were no other medical problems or medication usage that would predispose patient to acute pancreatitis. CT Abdomen showed previous cholecystectomy and hepatic steatosis. MRCP revealed normal caliber of common bile duct (CBD) without stones and ansa pancreatica. Patient’s pain improved after conservative management. EUS showed thin caliber of pancreatic duct with regular contour. No ERCP was performed and patient was discharged home on Creon. Patient did not present with further episodes of pancreatitis.
Discussion: Findings from our case and literature review show that ansa pancreatica increases the risk of acute pancreatitis by decreasing patency of the accessory duct. However, this relationship has not been well-defined in the literature. In our case, no intervention was needed to improve the drainage of the ansa loop and it is not completely clear whether the presence of these two pathologies was a coincidence or if ansa pancreatica was the underlying etiology for pancreatitis. Clinicians, nonetheless, should be aware of this important anatomic variant and further investigate its presence especially in patients with idiopathic, recurrent pancreatitis.
Figure: Figure 1: Coronal MRCP image showing ansa pancreatica variation as the duct of Santorini (arrow) forms a sigmoid curve while coursing to the duct of Wirsung
Disclosures: Aimen Farooq indicated no relevant financial relationships. Baha Aldeen Bani Fawwaz indicated no relevant financial relationships. Rima Shobar indicated no relevant financial relationships. Abu Hurairah indicated no relevant financial relationships.
Aimen Farooq, MD, Baha Aldeen Bani Fawwaz, MD, Rima Shobar, MD, MS, Abu Hurairah, MD. P0095 - Ansa Pancreatica: A Rare Cause of Acute Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
