A giant retention cyst of the pancreas (cystic dilatation of dorsal pancreatic duct) associated with pancreas divisum

J Gastroenterol. 2002;37(12):1079-82. doi: 10.1007/s005350200182.

Abstract

We describe a rare case of pancreas divisum associated with a giant retention cyst (cystic dilatation of the dorsal pancreatic duct), presumably formed following obstruction of the minor papilla. The patient was treated by pancreatico(cysto)jejunostomy. A 50-year-old man was admitted with complaints of increasing upper abdominal distension and body weight loss. There was no previous history of pancreatitis, gallstones, drinking, or abdominal injury. An elastic-hard tumor-like resistance was palpable in the upper abdomen. Computed tomography and ultrasound (US) examinations revealed a giant cystic lesion expanding from the pancreas head to the tail. Endoscopic retrograde cholangiopancreatography findings showed a looping pancreatic duct which drained only the head and uncinate process of the pancreas to the main papilla. A US-guided puncture to the cystic lesion revealed that the lesion continued to the main pancreatic duct in the tail of pancreas. The lesion was connected to a small cystic lesion, which was located inside the minor papilla, and ended there. The amylase level in liquid aspirated from the cyst was 37 869 IU/l, and the result of cytological examination of the liquid showed class II. A pancreatico(cysto)jejunostomy was performed, with the diagnosis being pancreas divisum associated with a retention cyst following obstruction of the minor papilla. The histological findings of a specimen from the cyst wall revealed that the wall was a pancreatic duct covered with mildly inflammatory duct epithelium; there was no evidence of neoplasm. The patient is currently well, and a CT examination 2 years after the operation showed disappearance of the cyst and normal appearance of the whole pancreas.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / surgery
  • Cholangiopancreatography, Endoscopic Retrograde / methods
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Pancreatic Diseases / complications
  • Pancreatic Diseases / diagnosis
  • Pancreatic Diseases / surgery*
  • Pancreatic Ducts / abnormalities*
  • Pancreatic Pseudocyst / complications
  • Pancreatic Pseudocyst / diagnosis*
  • Pancreatic Pseudocyst / surgery*
  • Pancreaticojejunostomy / methods
  • Risk Assessment
  • Severity of Illness Index
  • Tomography, X-Ray Computed
  • Treatment Outcome