Ann Hepatobiliary Pancreat Surg.  2020 Aug;24(3):381-387. 10.14701/ahbps.2020.24.3.381.

Recurrent pancreatitis in the setting of gallbladder agenesis,ansa pancreatica, Santorinicoele and eventual intraductal papillary mucinous neoplasia (IPMN)

• Lee SW
• Davidson CJ
• Kia Y
• Devereaux B
• Godinho S
• Appleyard M
• O’Rourke N
• Chandrasegaram MD

• KMID: 2505355
• DOI: http://doi.org/10.14701/ahbps.2020.24.3.381

Abstract

Gallbladder agenesis is a rare condition. Patients with gallbladder agenesis can present with biliary type symptoms and rarely pancreatitis. We present the case of a 35-year-old gentleman who was admitted and treated for recurrent pancreatitis on a background of gallbladder agenesis, ansa pancreatica and Santorinicoele. He has had several admissions with pancreatitis and has had multiple imaging modalities during these admissions which we delineate. We discuss this rare anatomical variant and describe the course and management of his illness leading up to his eventual diagnosis of intraductal papillary neoplasia (IPMN).

Keyword

Gallbladder agenesis; Santorinicoele; Ansa pancreatica; Recurrent pancreatitis; Intraductal papillary neoplasia; IPMN

Figure

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  Fig. 1 Magnetic Resonance Cholangiopancreatography (MRCP) image confirming an absent gallbladder and defining the biliary anatomy. The main pancreatic duct (hollow red arrow) is shown. There is a dilated duct of Santorini draining into the minor papilla (solid red arrow) and an ansa pancreatica (yellow solid arrow) connecting the main pancreatic duct and duct of Santorini.

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  Fig. 2 Computed tomography (CT) of the abdomen showing pancreatitis with peripancreatic fat stranding (red arrow) with free fluid extending to the pelvis (yellow arrow).

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  Fig. 3 Magnetic Resonance Cholangiopancreatography (MRCP) image showing mild intrahepatic duct dilatation and a dilated common bile duct which measures 8 mm at the porta hepatis and 15 mm at the mid CBD with smooth distal tapering. The main pancreatic duct (hollow red arrow) is prominent at 3 mm, there is a Santorinicoele (solid red arrow) draining into minor papilla and an ansa pancreatica (yellow solid arrow) between the main pancreatic duct and Santorinicoele which is more prominent and dilated compared to Fig. 1 which was an MRCP done the month prior.

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  Fig. 4 Mucin seen exuding the minor papilla at endoscopy.

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  Fig. 5 Spyglass view of main pancreatic duct.

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