Presentation
Work up for chronic recurrent abdominal pain.
Patient Data
The dorsal pancreatic duct (Santorini duct) is prominent and directly entering the minor papilla with focal dilatation proximal to its duodenal insertion known as santorinicele.
The ventral panctratic duct (Wirsung duct) is smaller and entring the major papilla with common bile duct. There is also a tiny communication between the dorsal and ventral ducts.
Extra and central intrahepatic bile ducts are dilated, and CBD measured 10 mm in diameter. There is no filling defect within the CBD.
Case Discussion
Features are consistent with the incomplete pancreas divisum, characterized by the dorsal pancreatic duct directly entering the minor papilla when the small ventral pancreatic duct enters the major papilla, with a tiny communication between both ducts.
Pancreatic divisum can result in a santorinicele, a focal dilatation of the dorsal duct, immediately before the minor papilla.
The pancreas divisum usually is asymptomatic, although this variant is found more frequently in patients with chronic abdominal pain and recurrent idiopathic pancreatitis.
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