Context There are anatomic variations of pancreatic ducts with ansa pancreatica being a rare anatomic variant where the duct of Santorini forms a loop or S-shape. It has been postulated that ansa pancreatica predisposes people to acute pancreatitis. We report a case of ansa pancreatica, review the literature and examine its relation to acute pancreatitis. Case report A sixty-eight-year-old male, with a previous episode of acute pancreatitis, presented to the emergency department with epigastric pain, was found to have a lipase of 5,399 U/L and a normal right upper quadrant ultrasound. Metabolic workup, triglycerides, and IgG4 levels were all within normal limits. There were no other medical problems or medication usage which would predispose the patient to acute pancreatitis. A magnetic resonance cholangiopancreatography was performed which showed a dilated pancreatic duct to 6 mm in the head and body and also evidence of ansa pancreatica. Following resolution of the acute episode, an endoscopic retrograde cholangiopancreatography revealed moderate diffuse dilation in the ventral pancreatic duct with an ansa loop in the pancreatic duct head, indicating ansa pancreatica. A sphincterotomy of the major papilla was performed and a temporary stent was placed. The patient has had no additional acute pancreatitis episodes. Conclusion Findings from our case and literature review show that ansa pancreatica increases one’s risk of acute pancreatitis. A detailed investigation in cases of idiopathic acute pancreatitis can play a key role in early identification and treatment of ansa pancreatica and can improve clinical outcomes.
Justin S Kosirog, Brian R Boulay, Cemal Yazici