Presentation
Chronic intermittent abdominal discomfort with persistently elevated amylase levels.
Patient Data
Common bile duct (CBD) and main pancreatic duct (MPD) are normal in caliber. However, the MPD is seen forming a small loop in the pancreatic head region of the pancreatic duct. Features are suggestive of a loop-type meandering main pancreatic duct (MMPD).
No definite long common channel seen in the duodenal wall to suggest pancreaticobiliary maljunction. No accessory pancreatic duct to suggest pancreatic divisum. No focal pancreatic cystic lesions.
No abnormal dilatation or cystic change of the intrahepatic or extrahepatic biliary tree to suggest choledochal cyst formation. Common bile duct shows smooth distal tapering. No definite intraductal filling defects. Gallbladder is unremarkable with no gallstones.
Liver is normal in size. No abnormal focal signal intensity or restricted diffusion. Spleen, adrenals and included kidneys are unremarkable.
No ascites. No enlarged upper abdominal lymph nodes.
Conclusion: Meandering main pancreatic duct (MMPD), loop-type variant is suggested.
Case Discussion
In view of clinical suspicion of recurrent chronic pancreatitis and isolated MRCP findings of looped spiral appearance of the main pancreatic duct (MPD), the clinicoradiological diagnosis was likely due to a meandering main pancreatic duct (MMPD) loop-type variant.
Under the classification of meandering main pancreatic duct (MMPD), two common types have been described in literature
reverse Z-type (hairpin appearance)
loop-type (as in our case)
MMPD has been reported at a higher frequency in patients with idiopathic recurrent acute pancreatitis (IRAP) and suggested as a contributing factor.
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