P1121 - Asymptomatic Agenesis of the Dorsal Pancreas: A Rare Incidental Finding on Cross Sectional Imaging

Mohammad Abdallah, MBBS¹, Thomas Houghton, DO¹, Michelle Baliss, DO¹, Kevin Kline, MD¹, Sreeram Parupudi, MD^2
1University of Texas Medical Branch, Galveston, TX; ²University of Texas Medical Branch at Galveston, Galveston, TX

Introduction: Agenesis of the dorsal pancreas is a rare congenital abnormality which results from failure of the dorsal pancreatic bud progression into the tail and body of the pancreas. In adults, this abnormality has been associated with diabetes, pancreatic insufficiency, and pancreatitis. We present a case of agenesis of dorsal pancreas incidentally found on imaging with no associated pathology.

Case Description/Methods: 29-year-old male with a history of renal calculi presented to primary care clinic with several days of right testicular pain. He had no symptoms of pancreatic insufficiency, pancreatitis, diabetes or biliary disease. Physical exam including abdominal exam was unremarkable. Workup including urinalysis and testicular ultrasound was unremarkable. Over the next few months, the patient’s symptoms did not fully resolve, so a CT abdomen without contrast was performed to rule out renal calculi. CT showed no evidence of renal disease, but pancreatic evaluation on imaging showed absence of pancreatic tail and part of the pancreatic body and normal pancreatic head and neck without evidence of inflammation or duct pathology (figure 1). On further questioning, the patient denied any history of pancreatic insufficiency, pancreatitis, diabetes or biliary disease or any related symptoms. Liver chemistries and Hgb a1c were within normal limits. He was advised to abstain from alcohol, and on 6-month follow-up, he remained asymptomatic with no associated biochemical abnormalities.

Discussion: During embryogenesis the pancreas develops from a union of the ventral and dorsal buds arising from the 2^nd part of duodenum. Abnormal development of any bud or abnormal union can result in complications stemming from dysfunction in pancreatic exocrine activities. The pancreatic head and uncinate process usually arise from ventral bud, while the pancreatic neck, body and tail arise from dorsal bud. During 7^th week of gestation ventral bud rotates to fuse with dorsal bud and form mature pancreas.
Dorsal pancreatic agenesis, where the bud fails to form, is an extremely rare condition that can be either genetic or sporadic. While most patients with dorsal agenesis present with a sentinel sign or event such as pancreatitis or new unexplained diabetes, seemingly asymptomatic patients with this finding noted on imaging should be evaluated for complications of agenesis before it is deemed to be an incidental finding with no clinical implications.


Figure: Figure 1: Absence of pancreatic tail and part of the pancreatic body and normal pancreatic head and neck


Disclosures:
Mohammad Abdallah indicated no relevant financial relationships.
Thomas Houghton indicated no relevant financial relationships.
Michelle Baliss indicated no relevant financial relationships.
Kevin Kline indicated no relevant financial relationships.
Sreeram Parupudi indicated no relevant financial relationships.


Mohammad Abdallah, MBBS¹, Thomas Houghton, DO¹, Michelle Baliss, DO¹, Kevin Kline, MD¹, Sreeram Parupudi, MD². P1121 - Asymptomatic Agenesis of the Dorsal Pancreas: A Rare Incidental Finding on Cross Sectional Imaging, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.