Sanada Y, Yoshizawa Y, Chiba M, Nemoto H, Midorikawa T, Kumada K
Department of Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
J Pediatr Surg. 1995 May;30(5):665-7. doi: 10.1016/0022-3468(95)90685-1.
Pancreas divisum results in drainage of most pancreatic secretions through the minor papilla via the dorsal duct, and the association of minor papilla stenosis has been implicated as a cause of pancreatitis. Most of the reported cases represent pancreatitis confined to the dorsal part. The authors treated a 10-year-old boy with recurrent pancreatitis that was substantially more severe in the ventral part. The patient was referred with a brief history of abdominal pain and had undergone a laparotomy when segmental ventral pancreatitis had been observed. Severe pancreatitis and acute renal failure developed, which required drainage of the lesser sac and hemodialysis, respectively. After 5 months, he had another episode that subsequently led to a pseudocyst in the ventral part. Endoscopic retrograde cholangiopancreatography via minor papilla showed a normal-caliber dorsal duct communicating with a part of the fine ventral ducts. A normal biliary tree was shown, but no ventral duct was visualized by cannulation to the major papilla of Vater. Dual sphincteroplasties and a cholecystectomy were performed. The minor papilla was stenotic and admitted only the finest lacrimal duct probe. The orifice of the ventral duct could not be observed. Thus it was clarified that the dorsal duct with its stenotic orifice had drained both the dorsal and ventral pancreas. The patient has remained asymptomatic over 36 months postoperatively. Despite their limited experience, the authors believe that (1) this anatomic variant led to ventral pancreatitis, and (2) the sphincteroplasty of the minor papilla was successful.
胰腺分裂导致大多数胰腺分泌物通过背侧导管经小乳头引流，小乳头狭窄被认为是胰腺炎的一个病因。大多数报道的病例表现为局限于背侧部分的胰腺炎。本文作者治疗了一名10岁复发性胰腺炎男孩，其腹侧胰腺炎病情严重得多。该患者因腹痛病史简短前来就诊，在观察到节段性腹侧胰腺炎时已接受剖腹手术。分别出现了严重胰腺炎和急性肾衰竭，前者需要小网膜囊引流，后者需要血液透析。5个月后，他又发作了一次，随后腹侧出现假性囊肿。经小乳头的内镜逆行胰胆管造影显示，正常管径的背侧导管与部分纤细的腹侧导管相通。胆管树正常，但通过向Vater主乳头插管未显示腹侧导管。实施了双重括约肌成形术和胆囊切除术。小乳头狭窄，仅能通过最细的泪道探针。未观察到腹侧导管开口。因此明确了狭窄开口的背侧导管引流了背侧和腹侧胰腺。术后36个月患者一直无症状。尽管经验有限，作者认为：（1）这种解剖变异导致了腹侧胰腺炎；（2）小乳头括约肌成形术是成功的。
