Neirouz Kammoun, Mohamed Hajri, Aziz Atallah, Rania Osmane, Lassaad Gharbi, Hafedh Mestiri
Surgery Department, Mongi Slim Hospital, Tunisia.
Surgery Department, Mongi Slim Hospital, Tunisia.
Int J Surg Case Rep. 2024 Oct;123:110244. doi: 10.1016/j.ijscr.2024.110244. Epub 2024 Sep 6.
Ansa pancreatica is an embryologic malformation where the accessory pancreatic duct is obliterated and replaced instead by a loop merging from the main duct. It is associated with recurrent acute pancreatitis.
1st case A 47-year-old male patient with a history of former alcoholism presented in the last three years five episodes of acute pancreatitis. He presented for a 6th episode. An MRCP was practiced revealing an ansa pancreatica. The patient undergoes an endoscopic sphincterotomy. 2nd case It is a 74-year-old woman patient, who presented for a second episode of acute pancreatitis. The investigations did not reveal a gallstone disease or any metabolic abnormalities. An MRCP was performed showing an ansa pancreatica. 3rd case A 27-year-old male admitted for acute pancreatitis. Initial abdominal ultrasound revealed gallbladder sludge along with a dilated common bile duct (CBD). The patient underwent a cholecystectomy with cholangiography. The cholangiography revealed an ansa pancreatica. The post-operative recovery was uneventful.
Ansa pancreatica, is an embryological malformation consisting of the accessory pancreatic duct obliteration, near its junction with the common duct. This portion is replaced by an S-shaped loop joining the minor papilla. That can lead to clinical manifestations, particularly acute pancreatitis. Sphincterotomy targeting the minor papilla could improve symptoms and reduce pancreatitis recurrence. In case of failure, endoscopic ligation of the ansa deformity represents a good alternative.
Through these cases, we tried to illustrate different scenarios in which we discovered an ansa pancreatica and the management of such anatomic variance.
胰袢是一种胚胎发育畸形，副胰管闭塞，取而代之的是从主胰管发出的一个袢。它与复发性急性胰腺炎有关。
第一个病例 一名47岁男性患者，有酗酒史，在过去三年中发生过五次急性胰腺炎。此次因第六次发作前来就诊。进行了磁共振胰胆管造影（MRCP），显示为胰袢。患者接受了内镜下括约肌切开术。第二个病例 是一名74岁女性患者，因第二次急性胰腺炎发作前来就诊。检查未发现胆结石疾病或任何代谢异常。进行了MRCP，显示为胰袢。第三个病例 一名27岁男性因急性胰腺炎入院。最初的腹部超声显示胆囊泥沙样结石以及胆总管扩张。患者接受了胆囊切除术及胆管造影。胆管造影显示为胰袢。术后恢复顺利。
胰袢是一种胚胎发育畸形，表现为副胰管在与胆总管交界处附近闭塞。该部分被一个连接小乳头的S形袢所取代。这可能导致临床表现，尤其是急性胰腺炎。针对小乳头的括约肌切开术可改善症状并减少胰腺炎复发。若失败，内镜下结扎胰袢畸形是一个不错的选择。
通过这些病例，我们试图说明发现胰袢的不同情况以及对这种解剖变异的处理。
