Agenesis of the dorsal pancreas with chronic suppurative pancreatitis: Case report and literature review

Rationale:Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly of the pancreas. ADP is associated with some other medical problems such as diabetes mellitus, abdominal pain/bloating, pancreatitis, pancreatic neuroendocrine tumor and so on. In this study, we present a case of ADP with chronic suppurative pancreatitis, summarize the clinical characteristics of the reported cases in China and review the correlative literature.Patient concerns:A 51-year-old Chinese man, with a history of impaired fasting glucose, presented with jaundice, pruritus and dark urine. Laboratory analysis showed abnormal liver function and elevated carbohydrate antigen 19-9.Diagnoses:Contrast-enhanced computed tomography demonstrated a mass located at the head of pancreas and complete absence of the body and tail of pancreas. Endoscopic retrograde cholangiopancreatography demonstrated an eccentric malignant stricture about 1.6cm of distal common bile duct.Interventions:The patient underwent pancreaticoduodenectomy because of the suspicion of pancreatic tumor. The postoperative pathological result was chronic suppurative pancreatitis, with moderate hyperplasia in focal ductal epithelium.Outcomes:A long-term follow-up shows that the patient is asymptomatic with well-controlled diabetes mellitus and pancreatic exocrine insufficiency.Lessons:ADP is a quite rare congenital malformation of the pancreas with poorly-understood pathogenesis. The diagnosis of ADP depends on the imaging examination. The therapeutic strategy varies from person to person due to the different accompanying conditions.     

Metastasis from colon carcinoma in the dorsal pancreas of a patient with pancreas divisum: report of a case

The authors report the case of a 45-year-old woman who suffered from epigastric pain and was operated on 3 years before for colon cancer. The clinical investigation revealed that the patient had colon cancer metastasis to the dorsal pancreas of a pancreas divisum.     

Agenesis of the dorsal pancreas

Developmental anomalies of the pancreas have been reported but dorsal pancreatic agenesis is an extremely rare entity. We report an asymptomatic 62-year-old woman with complete agenesis of the dorsal pancreas. Abdominal computed tomography （CT） revealed a normal pancreatic head, but pancreatic body and tail were not visualized. Magnetic resonance imaging （MRI） findings were similar to CT. At magnetic resonance cholangiopancreatography （MRCP）, the major pancreatic duct was short and the dorsal pancreatic duct was not visualized. The final diagnosis was dorsal pancreatic agenesis.     

The course of traumatic pancreatitis in a patient with pancreas divisum: a case report

Background  

The peculiar anatomy of pancreatic ducts in pancreas divisum (PD) may interfere with the development of acute chronic pancreatitis. In the presented case, PD influenced the evolution of lesions after pancreatic trauma.     

Pulmonary embolism with acute pancreatitis: a case report and literature review

Acute pancreatitis is an inflammatory disease characterized by local tissue injury which can trigger a systemic inflammatory response. So vascular complications of pancreatitis are a major cause of morbidity and mortality. Pulmonary embolism in acute pancreatitis has been reported to be very rare. We reported a case of pulmonary embolism with acute pancreatitis. A 38-year-old woman broke out upper abdomen pain without definite inducement. She had no nausea and vomiting, fever, dyspnea, cough and expectoration, chest pain. The patient had been diagnosed with acute pancreatitis in local hospital. The patient was treated with antibiotics and proton pump inhibitors, and the abdomen pain was alleviated slightly. But the patient came forth cough and expectoration with a little blood, progressive dyspnea. A computed tomographic scan of the abdomen revealed pancreatitis. Subsequent computer tomography angiography of chest revealed pulmonary embolism (both down pulmonary arteries, left pulmonary artery and branch of right pulmonary artery). Dyspnea of the patient got well with thrombolytic treatment and anticoagulation therapy. Pulmonary embolism is a rare but potentially lethal complication of pancreatitis. Familiarity with this complication will aid in its early diagnosis, therapy and prevent pulmonary embolism, a rare but catastrophic phenomenon.     

Primary hyperparathyroidism presenting as recurrent acute pancreatitis: A case report and review of literature

The association between pancreatitis and primary hyperparathyroidism (PHPT) is controversial. We report a 32-year-old man who presented with recurrent episodes of acute pancreatitis. Primary hyperparathyroidism was diagnosed after the fourth episode of pancreatitis. He had no additional risk factors for pancreatitis. Eighteen months after successful parathyroid surgery, there has been no recurrence of abdominal pain and his serum calcium is within the normal range.     

Riedel's thyroiditis in a patient with recurrent subacute thyroiditis: a case report and review of the literature

Riedel's thyroiditis is a rare form of chronic thyroiditis, characterised by a fibroinflammatory process that partially destroys the thyroid and often involves surrounding tissues. The relationship of Riedel's thyroiditis to other forms of thyroiditis is not clear. A case of Riedel's thyroiditis in a 51-year-old woman presenting with symptoms of subacute thyroiditis, is reported. She was diagnosed with subacute thyroiditis based on clinical manifestation and laboratory results. She was treated with glucocorticoids for six weeks, and then followed-up for 12 months. Three years later, she visited with tenderness and enlargement of thyroid mass, and laboratory and radiology findings suggested that she had a malignant thyroid tumor as well as subacute thyroiditis. After thyroidectomy, histopathologic findings showed that she had Riedel's thyroiditis in the presence of subacute thyroiditis. Until now, few cases of Riedel's thyroiditis in patients with a history of subacute thyroiditis have been reported in the literature. Although the etiology of Riedel's thyroiditis is unknown, it may develop in the course of subacute thyroiditis.     

Post-gastrectomy acute pancreatitis in a patient with gastric carcinoma and pancreas divisum

Gastrectomy is commonly performed for both benign and malignant lesions. Although the incidence of post-gastrectomy acute pancreatitis （PGAP） is low compared to other well-recognized post-operative complications, it has been reported to be associated with a high mortality rate. In this article, we describe a 70-year-old man with asymptomatic pancreatic divisum who underwent palliative subtotal gastrectomy for an advanced gastric cancer with liver metastasis. His postoperative course was complicated by acute pancreatitis and intra-abdominal sepsis. The patient eventually succumbed to multiple organ failure despite surgical debridement and drainage, together with aggressive antibiotic therapy and nutritional support. For patients with pancreas divisum or dominant duct of Santorini who fail to follow the normal post-operative course after gastrectomy, clinicians should be alert to the possibility of PGAP as one of the potential diagnoses. Early detection and aggressive treatment of PGAP might improve the prognosis.     

Agenesis of the dorsal pancreas (ADP) and pancreatitis - is there an association?

Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly. We describe four patients with ADP presenting with acute pancreatitis. One patient had diabetes mellitus and another had malrotation of duodenum as an additional feature. All patients improved on conservative management.     

Young female with pancreaticobiliary maljunction presenting with acute pancreatitis: a case report and review of the literature

We report a case of pancreaticobiliary maljunction which presented with acute pancreatitis. Pancreaticobiliary maljunction and its complications are mostly observed in the Asian population. There are only few western publications concerning this subject. We reviewed the literature for current knowledge and opinions concerning the pathophysiology and optimal treatment, with special emphasis on the oncologic aspect of this condition. Those patients without a choledochal cyst should at least receive a prophylactic cholecystectomy. Firstly, to prevent further pancreatitis due to biliopancreatic reflux more or less promoted by gallbladder contraction, and secondly, more important, to prevent the occurrence of gallbladder cancer. Patients with choledochal cyst should receive a prophylactic cholecystectomy, and an excision of the extrahepatic bile duct, followed by hepaticojejunostomy.     

Chronic pancreatitis with pancreas divisum treated with pylorus-preserving pancreatoduodenectomy: a case report

Pancreas divisum, the most common congenital variant of pancreatic ductal anatomy, occurs when the ventral and dorsal pancreatic-buds fail to fuse. Herein, we report on a 42-year-old male suffering from chronic pancreatitis with pancreas divisum. Magnetic resonance cholangiopancreatography confirmed this diagnosis. A pylorus-preserving pancreatoduodenectomy was then performed. Pathological examination of the pancreas demonstrated chronic pancreatitis without malignancy. The postoperative clinical course was uneventful, and the patient was discharged 10 days after surgery.     

Multimodal approach and long-term survival in a patient with recurrent metastatic acinar cell carcinoma of the pancreas: A case report

Pancreatic acinar cell carcinoma is an uncommon neoplasm of the exocrine pancreas associated with a poor prognosis, especially when found to be metastatic. Since there are a lack of large studies and prospective, randomized data, no consensus treatment guidelines are available. Here, we report a case of a patient with recurrent metastatic acinar cell carcinoma involving the liver who had presented initially with pancreatic panniculitis. She received chemotherapy with capecitabine and oxaliplatin prior to resection of her primary tumor and liver metastases, after which she experienced a 30 months recurrence-free survival. Upon relapse, she was treated with a combination of capecitabine and oxaliplatin followed by maintenance capecitabine. Now, more than seven years after initial diagnosis, the patient remains stable without evidence of active disease. This case highlights the possibility of therapeutic success even for a patient initially deemed unresectable due to a poor performance status who responded to fluoropyrimidine-based therapy.