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Shyam Sundar et al 10.5005/jp-journals-10007-1333
caSe repOrt

Meandering Pancreatic Duct as a Cause of Idiopathic

Recurrent Pancreatitis

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1 Shyam Sundar, Balaji Purushotham, Rajkumar Rathinasamy, Prabu Kathiresan
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ABSTRACT continuous, and not associated with food intake. Patient
Idiopathic pancreatitis contribute to about 20% of acute and had similar episode 5 years before where she was diag-
recurrent pancreatitis. Here we present a case of loop-type nosed with spontaneous biliary peritonitis and lapa-
variant of meandering pancreatitis. A patient with a very rare rostomy was performed. Since then she has recurrent
anomaly of the main pancreatic duct presented with recurrent episodes of pancreatitis for which she had recurrent
episodes of pancreatitis.
hospitalization and managed conservatively.
Keywords: Anomalous pancreatic biliary junction, Idiopathic On admission, her serum amylase and serum lipase
pancreatitis, Loop type, Meandering pancreatic duct.
levels were normal. Aspartate transaminase, alanine
How to cite this article: Sundar S, Purushotham B, transaminase, gamma-glutamyl transferase, total bili-
Rathinasamy R, Kathiresan P. Meandering Pancreatic Duct
as a Cause of Idiopathic Recurrent Pancreatitis. World J Lap rubin, and serum calcium levels were normal. Serum
Surg 2018;11(1):48-50. triglycerides and parathormone levels were normal.
Ultrasound of abdomen showed dilated main pan-
Source of support: Nil
creatic duct. There was no evidence of gallstones or
Conflict of interest: None
sludge. The 320-slice computed tomography of abdomen
revealed a slip of pancreatic tissue anterior to the head
INTRODUCTION measuring 3 × 1.7 × 1.2 cm representing the ventral pan-

Acute pancreatitis is serious illness with fatal outcomes. creas. Its duct measuring 3 mm in diameter is seen to
Some common causes include alcohol consumption, gall open into distal common bile duct. There is reduction in
stones, autoimmunity, trauma, and several anatomical parenchyma with dilatation of the main pancreatic duct
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anomalies, such as anomalous pancreatic biliary junc- which measures 6.5 mm. Replaced right hepatic artery
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tion and pancreatic divisum. Idiopathic pancreatitis passes along the posterior surface of head of pancreas.
includes 20% of cause of pancreatitis and 30% incidence Common bile duct and cystic duct shows mild fusi-
of recurrent pancreatitis. Recurrent pancreatitis is usually form dilatation. Upper gastrointestinal endoscopy was
performed, which showed no abnormality. Magnetic
associated with pancreatic ductal dilatation.
The main pancreatic duct normally has obtuse angle resonance cholangiopancreaticogram (MRCP) showed
curve from tail and body of pancreas to major ampulla. meandering pancreatic duct of loop variety with dilata-
tion of main pancreatic duct (Figs 1 to 3). Patient was
Occasionally, the ventral duct in the head of the pancreas put on nil per oral, O support, and nasogastric tube
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has abnormal curvature with localized spiral or hairpin was inserted. Parenteral fluids were given and managed
curve. This anomaly is known as meandering pancreatic
duct. This type of anomaly can cause ductal hypertension
and may be the reason for onset of idiopathic recurrent
pancreatitis.

CASE REPORT

A 13-year-old female presented with abdominal pain
radiating to the back for 3 days. The pain was acute,

1 Fellow, Professor and Head, Assistant Professor
3,4
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1-4 Department of Minimal Access Surgery, Madras Medical
College, Chennai, Tamil Nadu, India
Corresponding Author: Shyam Sundar, Fellow, Department
of Minimal Access Surgery, Madras Medical College, Chennai
Tamil Nadu, India, e-mail: shyamsundarsr89@gmail.com
Fig. 1: Loop variant of main pancreatic duct
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