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pancreatic divisum

Ankur Gupta, Praveer Rai, Vivek Singh, Rakesh Kumar Gupta, Vivek Anand Saraswat
BACKGROUND: Knowledge about anatomic variations in intrahepatic biliary ducts (IHBD) is relevant for performing biliary drainage and for avoiding bile duct injury during cholecystectomy and liver resections. Low insertion of cystic duct (LICD) is a common anatomic variant. Pancreas divisum is the commonest congenital anomaly of pancreas; it has been causally linked with recurrent acute pancreatitis (RAP). METHODS: Magnetic resonance cholangiopancreaticography (MRCP) images of 500 consecutive patients were reviewed for anatomic variants of IHBD, cystic duct, and pancreatic duct...
September 2016: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Nicholas G Brown, Douglas A Howell, Brian C Brauer, John Walker, Sachin Wani, Raj J Shah
BACKGROUND AND AIMS: Pancreatic duct (PD) cannulation via the major papilla may be compromised by downstream obstruction of the ventral PD from a stone or stricture. In patients with a patent accessory PD, cannulation of the minor papilla permits stenting or stone removal upstream of the ventral PD obstruction. Data on this technique are limited. METHODS: University of Colorado Hospital and Maine Medical Center endoscopy databases were queried for ERCPs with minor papilla cannulation...
August 13, 2016: Gastrointestinal Endoscopy
Piyush Somani Md, Udayakumar Navaneethan Md
Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. RAP is differentiated from chronic pancreatitis based on the presence of a normal morphological appearance of the pancreas between episodes. RAP can be due to a variety of etiologies including common bile duct stones or sludge, sphincter of Oddi dysfunction (SOD), pancreas divisum (PD), anomalous pancreaticobiliary junction, genetic mutations, and alcohol related. In approximately 30 % of patients, the etiology of RAP is unclear and the term "idiopathic" is used...
September 2016: Current Treatment Options in Gastroenterology
Woo Jin Jeong
No abstract text is available yet for this article.
2016: Endoscopy
Surinder Singh Rana, Ravi Sharma, Puneet Chhabra, Vishal Sharma, Rajesh Gupta, Deepak Kumar Bhasin
BACKGROUND: Splenic pseudocysts (SP) are a rare consequence of both acute and chronic pancreatitis. Surgery has been conventional treatment for SP and literature on role of endoscopic treatment is scant. In this study, we retrospectively evaluated SP clinical and radiological characteristics as well as the outcome following endoscopic drainage. METHODS: Retrospective analysis of SP patients seen at our unit from January 2002 to June 2015. All patients were treated with attempted endoscopic transpapillary drainage with a nasopancreatic drain or stent...
July 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
C Mel Wilcox, Toni Seay, Hwasoon Kim, Shyam Varadarajulu
OBJECTIVES: Although idiopathic pancreatitis is common, the natural history is not well studied, and the best diagnostic approach to both single and multiple attacks remains undefined. METHODS: We prospectively evaluated patients with idiopathic pancreatitis over a 10-year period, and clinical information for each episode was reviewed. Endoscopic ultrasound (EUS) was performed in all patients. Patients with microlithiasis or bile duct stones were referred for cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP), respectively...
September 2016: American Journal of Gastroenterology
Tetsuya Takikawa, Atsushi Kanno, Atsushi Masamune, Seiji Hongo, Naoki Yoshida, Eriko Nakano, Shin Miura, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Morihisa Hirota, Tooru Shimosegawa
A 32-year-old woman was referred due to abdominal pain and elevated liver enzymes. Computed tomography and magnetic resonance imaging showed ectopic opening of the common bile duct (CBD) into the duodenal bulb. Esophagogastroduodenoscopy showed a hemispheric bulge in the duodenal bulb. Endoscopic retrograde cholangiopancreatography (ERCP) revealed the bulge to be cystic dilatation of the CBD. ERCP also showed no communication between the ventral and dorsal pancreatic ducts. We diagnosed the patient with ectopic opening of the CBD accompanied by choledochocele and pancreas divisum...
2016: Internal Medicine
Eugene P DiMagno, Matthew J DiMagno
On May 16, 2015 at the invitation of the American Gastroenterological Association Institute Council E.P.D. presented a state-of-the-art lecture at Digestive Disease Week 2015. The aims were to discuss a selection of landmark papers in chronic pancreatitis (CP) that influence modern management and to conclude by suggesting some future directions. This is based on that presentation. We will specifically review the following: duct anatomy and pancreas divisum, description of chronic relapsing pancreatitis and its differentiation from recurrent acute pancreatitis and established CP (ECP), natural histories and gene discoveries of alcoholic, idiopathic and hereditary pancreatitis, development of pancreatic cancer in CP, exocrine pancreatic insufficiency and calculation of dose and delivery of enzymes, endoscopic ultrasonography, and autoimmune pancreatitis...
May 2016: Pancreas
Suryaprakash Bhandari, Atul Sharma, Rajesh Bathini, Amit Maydeo
BACKGROUND AND AIMS: Spontaneous intestinal migration of pancreatic stents is a known phenomenon. However, retrieval of a proximally migrated pancreatic stent (PMPS) poses a therapeutic challenge. The primary aim of this study was to evaluate technical success of endoscopic retrograde of cholangiopancreatography (ERCP) for extraction of PMPS, including number of sessions, need of surgery for failures and intervention-induced adverse events. The secondary outcome was to evaluate long-term effects of PMPS on the ductal morphology...
March 2016: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Malay Sharma, Amit Pathak, Chittapuram Srinivasan Rameshbabu, Praveer Rai, Vijendra Kirnake, Abid Shoukat
Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. Endoscopic ultrasound (EUS) is often performed to evaluate idiopathic pancreatitis and has been shown to have high accuracy in diagnosis of PD. The different techniques to identify PD by linear EUS have been described differently by different authors. If EUS is done with a proper technique it can be a valuable tool in the diagnosis of PD. The anatomical and technical background of different signs has not been described so far...
January 2016: Endoscopic Ultrasound
Muhammad Ali Taj, Sajida Qureshi, Shahriyar Ghazanfar, Arif Rasheed Siddiqui, Saad Khalid Niaz, M Saeed Quraishy, Muhammad Shahid
OBJECTIVE: To evaluate the complications, technical success, diagnostic evaluation and various endoscopic management options in patients with pancreas divisum. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Endoscopy Suite, Surgical Unit 4, Civil Hospital, Karachi, from January 2007 to December 2013. METHODOLOGY: All Endoscopic Retrograde Cholangio-pancreatography (ERCPs) procedure performed in patients with pancreas divisum were analyzed...
February 2016: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Yi Lu, Bin Xu, Lu Chen, Li-Ke Bie, Biao Gong
BACKGROUND/AIMS: To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of symptomatic pancreas divisum (PD) and to discuss whether ERCP procedures and outcomes in younger patients differ from those of adults. METHODS: Symptomatic patients with PD were included in the study and divided into underaged (age ≤17 years) and adult (age ≥18 years) group. The clinical information of each patient was reviewed, and then the patients were contacted by telephone or their medical records were reviewed to determine their long-term followup outcomes...
May 23, 2016: Gut and Liver
Richa Arora, Y Jyotsna Rani
Anatomic variations and developmental anomalies of the pancreas and pancreatic duct are often noticed as an incidental finding on imaging. However, knowledge of these variants may prove to be crucial during surgery as it may prevent unintentional ductal injury. We report a case of pancreatic divisum with codominant ventral duct mimicking double pancreatic ducts along with the elongated uncinate process of pancreas. It was picked incidentally on magnetic resonance cholangiopancreaticography (MRCP) done to rule out cholelithiasis and choledocholithiasis...
October 2015: Quantitative Imaging in Medicine and Surgery
Rohit Das, Dhiraj Yadav, Georgios I Papachristou
Recurrent acute pancreatitis (RAP) is a challenging condition that can lead to chronic pancreatitis and long-term morbidity. Etiology-based treatment can potentially have an impact on the natural history of RAP and its progression to chronic pancreatitis. In cases of divisum-associated RAP and idiopathic RAP, several studies have been performed to evaluate the efficacy of endoscopic therapy in alleviation of symptoms and frequency of AP events. This review discusses the literature available on these topic as well as touching on the role of endoscopic therapy in smoldering acute pancreatitis...
October 2015: Gastrointestinal Endoscopy Clinics of North America
Isaac Raijman, Paul R Tarnasky, Sandeep Patel, Douglas S Fishman, Sri Naveen Surapaneni, Laura Rosenkranz, Jayant P Talreja, Dang Nguyen, Monica Gaidhane, Michel Kahaleh
BACKGROUND AND OBJECTIVES: Endoscopic drainage is the first consideration in treating pancreatic fluid collections (PFCs). Recent data suggests it may be useful in complicated PFCs as well. Most of the available data assess the use of plastic stents, but scarce data exists on metal stent management of PFCs. The aim of our study to evaluate the efficacy and safety of a metal stent in the management of PFCs. PATIENTS AND METHODS: Data were collected prospectively on 47 patients diagnosed with PFCs from March 2007 to August 2011 at 3 tertiary care centers...
July 2015: Endoscopic Ultrasound
Srinath Chinnakotla, Gregory J Beilman, Ty B Dunn, Melena D Bellin, Martin L Freeman, David M Radosevich, Mustafa Arain, Stuart K Amateau, J Shawn Mallery, Sarah J Schwarzenberg, Alfred Clavel, Joshua Wilhelm, R Paul Robertson, Louise Berry, Marie Cook, Bernhard J Hering, David E R Sutherland, Timothy L Pruett
OBJECTIVE: Our objective was to analyze factors predicting outcomes after a total pancreatectomy and islet autotransplantation (TP-IAT). BACKGROUND: Chronic pancreatitis (CP) is increasingly treated by a TP-IAT. Postoperative outcomes are generally favorable, but a minority of patients fare poorly. METHODS: In our single-centered study, we analyzed the records of 581 patients with CP who underwent a TP-IAT. Endpoints included persistent postoperative "pancreatic pain" similar to preoperative levels, narcotic use for any reason, and islet graft failure at 1 year...
October 2015: Annals of Surgery
Manphool Singhal, Anupam Lal, Rakesh Kochhar, Usha Dutta, Birinder Nagi, Jai Dev Wig, Kartar Singh
A 35-year-old man, a chronic alcohol consumer with clinical features of acute pancreatitis, presented with obstructive jaundice and melena. On radiological evaluation two large pseudocysts, one each in relation to pancreatic head and tail regions, were noted with a gastro-duodenal artery pseudoaneurysm in the pseudocyst in the head region. He also had narrowing of the common bile duct. On endoscopic retrograde cholangiopancreatography (ERCP) he had evidence of chronic pancreatitis with morphology of pancreas divisum with disruption of both the dorsal and ventral ducts...
April 2009: Clinical Journal of Gastroenterology
Shigenori Yamada, Takashi Muraki, Shuichi Yokosawa, Norikazu Arakura, Shigeyuki Kawa, Katsuhiko Ishizaka, Manabu Nakamura
A 52-year-old man was admitted to our hospital complaining of abdominal pain. A blood test showed high serum levels of biliary enzymes and amylase. Surprisingly, a computed tomography scan revealed complete separation of the ventral and dorsal pancreas and swelling of the ventral pancreas with choledocholithiasis. Surgical cholecystectomy was performed to remove the bile duct stones after endoscopic removal was unsuccessful. The complete separation of the pancreatic parenchyma caused by ventral pancreas malrotation seen in this case is extremely rare, and may provide important information regarding embryologic development, deformity, and malfunction of the pancreas...
February 2012: Clinical Journal of Gastroenterology
Haq Nawaz, Adam Slivka, Georgios I Papachristou
A patient with modified multivisceral transplant developed recurrent acute pancreatitis (RAP) 1 year after transplant and was found to have graft pancreas divisum with otherwise negative work-up for identifying the etiology of RAP. Endoscopic retrograde cholangiopancreatography was performed with minor papilla sphincterotomy and pancreatic duct stent placement of the graft pancreas. The patient's symptoms resolved following endotherapy for a follow-up period of 2 years. This is a unique case of graft pancreatitis secondary to pancreas divisum...
January 2014: ACG Case Reports Journal
Robert T Lapp, Grant F Hutchins
Several case reports on endoscopic resection of minor papilla adenomas exist in the literature. However, there are no reported cases of endoscopic resection in patients with minor papilla adenomas with associated familial adenomatous polyposis (FAP) and pancreas divisum. We report a case of a minor papilla adenoma in a patient with FAP and pancreas divisum. The case demonstrates a new association between these disease processes. Defining pancreatic ductal anatomy prior to endoscopic intervention is essential...
October 2013: ACG Case Reports Journal
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