Adult ; Diagnosis, Differential ; Female ; Humans ; Pancreas ; abnormalities ; Steatorrhea ; etiology

Most reported cases of intraductal papillary mucinous neoplasms (IPMNs) originate from Wirsung's duct or their branches. IPMNs arising from Santorini's duct and its branches have rarely been reported. Eight cases of IPMN arising from Santorini's duct have been published worldwide. However, these cases are associated with incomplete type of pancreas divisum. Recently, one report of IPMN with complete absence of Wirsung's duct has been reported. This patient was a 57-year-old woman who was admitted to the hospital due to progressive jaundice. On endoscopic retrograde cholangiopancreatography, there was a severely bulging ampulla of Vater and patulous minor papilla draining mucinous material and a cystic lesion communicating with the dilated Santorini's duct without any communication with Wirsung's duct. A pancreaticoduodenectomy was performed and the pathologic examination of resected specimen showed no evidence of Wirsung's duct, but an IPMN arising from Santorini's duct with peripancreatic lymph node metastasis. Herein, we report a case of invasive IPMN arising from pancreatic head without ventral pancreatic duct with a review of the relevant literatures.
*Carcinoma, Pancreatic Ductal ; Female ; Humans ; Middle Aged ; Pancreas/*abnormalities ; Pancreatic Ducts/*abnormalities ; *Pancreatic Neoplasms

Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients, some of these anomalies may lead to various clinical symptoms such as recurrent abdominal pain, nausea and vomiting. Recognition of these anomalies is important because these anomalies may be a surgically correctable cause of recurrent pancreatitis or the cause of gastric outlet obstruction. An awareness of these anomalies may help in surgical planning and prevent inadvertent ductal injury. The purpose of this article is to review normal pancreatic embryology, the appearance of ductal anatomic variants and developmental anomalies of the pancreas, with emphasis on magnetic resonance cholangiopancreaticography and multidetector computed tomography.
Cholangiopancreatography, Magnetic Resonance/*methods ; Humans ; Multidetector Computed Tomography/*methods ; Pancreas/abnormalities ; Pancreatic Diseases/congenital/pathology/radiography ; Pancreatic Ducts/*abnormalities

Gastric duplication cysts and dorsal pancreatic agenesis are rare congenital anomalies, and little is known of the association between these two anomalies. A 17-year-old woman was admitted with a cystic lung mass detected as part of a health screening program. Chest computed tomography (CT) showed a cystic lung lesion in the right lower lobe and an incidental cystic abdominal mass. She had no specific symptoms or signs. Abdominal CT and endoscopic ultrasonography (EUS) revealed a 9x7x5.5-cm cystic mass and agenesis of the body and tail of the pancreas. The cyst was removed successfully using laparoscopic gastric wedge resection. Microscopically, the muscle coat of the cyst wall was fused with the muscle layer of the stomach. Therefore, the cystic mass was diagnosed as a gastric duplication cyst. We present a patient with a pulmonary cystic lesion associated with two congenital anomalies: a gastric duplication cyst and dorsal pancreatic agenesis.
Adolescent ; Digestive System Abnormalities ; Endosonography ; Female ; Humans ; Lung ; Mass Screening ; Muscles ; Pancreas ; Stomach ; Thorax

Meckel diverticulum is the most common congenital abnormality of the small intestine. The condition occasionally involves invagination of the bowel lumen, leading to intussusception. We report a case in which intussusception secondary to an inverted Meckel diverticulum, together with an ectopic pancreas, occurred in an adult, and describe the associated radiologic, clinical and pathologic findings.
Abdomen ; Adult ; Congenital Abnormalities ; Diverticulum ; Humans ; Intestine, Small ; Intestines ; Intussusception* ; Meckel Diverticulum* ; Pancreas*

Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue encircling the second portion of the duodenum, and it is definitively diagnosed by endoscopic retrograde cholangiopancreatography. We present here a case of annular pancreas that was diagnosed by the minimum intensity projection technique of multidetector row CT. On the CT scan, the annular pancreas was demonstrated as the pancreatic tissue with an aberrant pancreatic duct encircling the duodenum.
Cholangiopancreatography, Endoscopic Retrograde ; Congenital Abnormalities ; Diagnosis* ; Duodenum ; Pancreas* ; Pancreatic Ducts ; Tomography, X-Ray Computed

Santorinicele, a focal cystic dilatation of the distal duct of Santorini, has been suggested as a possible cause of the relative stenosis of the accessory papilla, is associated with complete pancreas divisum, which results in acute episodes of pancreatitis or pain. This report describes a case of a santorinicele, which was initially detected by upper gastrointestinal endoscopy as a polypoid mass, in a patient with recurrent abdominal pain. The mass was subsequently proved to be a santorinicele containing a pancreatic duct stone associated with incomplete pancreas divisum on endoscopic retrograde pancreatography. To the best of our knowledge this is believed to be the first description of a santorinicele associated with these characteristic findings.
Adult ; Calculi/*diagnosis ; Dilatation, Pathologic ; Humans ; Male ; Pancreas/*abnormalities ; Pancreatic Diseases/*diagnosis ; Pancreatic Ducts/*pathology

The most common causes of acute pancreatitis are microlithiasis and alcohol. In pediatrics, anomalies in pancreaticobiliary system should be considered as possible causes. Among many anomalies, pancreas divisum associated with anomalous pancreaticobiliary ductal union (APBDU) is very rare. APBDU is associated with acute pancreatitis, choledochal cyst, and gallbladder cancer. Pancreas divisum is also a well known cause of acute recurrent pancreatitis. In adult cases with such conditions, the role of endoscopic management including sphincterotomy or stenting through the Santorini duct is well documented. However, it is still controversial to perform endoscopic retrograde cholangiopancreatography in pediatrics. Herein, we experienced a case of 4 year 7 month old female patient suffered from recurrent attacks of acute pancreatitis, which were caused by APBDU and incomplete pancreas divisum. She was treated by endoscopic sphincteretomy of both openings to the Santorini's and Wirsung's ducts. Thus, we report this interesting case with literature review.
Abnormalities, Multiple ; Acute Disease ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct/*abnormalities/surgery ; Female ; Humans ; Pancreas/*abnormalities ; Pancreatic Ducts/*abnormalities/surgery ; Pancreatitis/*diagnosis/etiology/surgery ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed

A 49-year-old female was admitted to our hospital for acute pancreatitis. The abdomen CT scan incidentally showed midline liver with hepatomegaly, centrally located gallbladder, pancreas truncation, right sided small bowel, left sided large bowel, interruption of the inferior vena cava with azygos continuation, preduodenal portal vein, and multiple spleens in the left upper quadrant. In MRCP, the head of pancreas was enlarged and short main pancreatic duct without accessory duct was showed. EUS revealed enlarged ventral pancreas with a main pancreatic duct of normal caliber, absence of the accessory pancreatic duct and the dorsal pancreas. She was diagnosed as polysplenia syndrome with agenesis of dorsal pancreas. It is a rare congenital anomaly frequently associated with various visceral anomalies including multiple spleens, impaired visceral lateralization, congenital heart diseases, gastrointestinal abnormalities and azygos continuation of the inferior vena cava. We report a case of polysplenia syndrome with agenesis of dorsal pancreas presenting acute pancreatitis.
Acute Disease ; Congenital Abnormalities/*diagnosis/ultrasonography ; Endosonography ; Female ; Heterotaxy Syndrome/*diagnosis/ultrasonography ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pancreas/abnormalities/ultrasonography ; Pancreatitis/*diagnosis ; Tomography, X-Ray Computed

OBJECTIVETo explore the value and safety of the application of enteral nutrition in pediatric surgery.

METHODSClinical data of 56 children patients who could not undertake oral feeding or those who required enteral nutrition by nasojejunal tube over 7 days in our ward from June 2007 to May 2013 were retrospectively analyzed. Children younger than one year old received enteral nutritional formulation Ai Er Shu mainly composed of short peptides or amino acids, and children over one year received Small peptide or Nengquansu mainly composed of short peptide.

RESULTSAmong these 56 children patients, primary disease was pancreatitis in 20 cases, lacerated wound in 10, duodenal perforation in 6, duodenal septum-shape stenosis in 9, annular pancreas in 6, and hepatoblastoma in 5. All the patients successfully completed the enteral nutrition therapy within 7-37 (18±9.9) days with good recovery. During the treatment, 5 cases (8.9%) developed diarrhea, 3 cases (5.4%) nausea and vomiting, 2 cases (3.6%) mild abdominal distension, 5 cases(8.9%) mild abdominal pain, and the symptoms were relieved after adjustment of nutrient solution concentration and infusion rate. After enteral nutrition for 10 days, the nutritional status of children was improved, and weight, blood red cell count, hemoglobin, serum albumin, prealbumin increased significantly (P<0.05).

CONCLUSIONApplication of enteral nutrition in pediatric surgery is safe and effective, which can improve the nutritional status of children and promote the recovery.

Abdominal Pain ; Child ; Diarrhea ; Enteral Nutrition ; Humans ; Infant ; Nutritional Status ; Pancreas ; abnormalities ; Pancreatic Diseases ; Pancreatitis ; Retrospective Studies