Korean J Gastroenterol.  2017 Apr;69(4):248-252. 10.4166/kjg.2017.69.4.248.

A Rare Case of Pancreas Divisum Accompanied by Acute Pancreatitis Following Endoscopic Hemostasis for Duodenal Ulcer Bleeding

• Choi YH
• Yoon SM
• Kim EB
• Oh Y
• Kim K
• Lee J
• Park SM
• Youn SJ

• KMID: 2383404
• DOI: http://doi.org/10.4166/kjg.2017.69.4.248

Abstract

Peptic ulcer bleeding is treated using endoscopic hemostasis using clips or bands. Pancreas divisum (PD), a congenital anomaly of the pancreas, usually has no clinical symptoms; however, pancreatitis may occur if there are disturbances in the drainage of pancreatic secretions. We report an unusual case of PD accompanied by acute pancreatitis, following endoscopic band ligation for duodenal ulcer bleeding. A 48-year-old woman was admitted to our hospital due to melena. An upper endoscopy revealed a small ulcer with oozing adjacent minor papilla. An endoscopic band ligation was performed on this lesion. Acute pancreatitis developed suddenly 6 hours after the band ligation and improved dramatically after removal of the band. Magnetic resonance cholangiopancreatography was performed, revealing complete PD. Endoscopic band ligation is known as the effective method for peptic ulcer bleeding; however, it should be used carefully in duodenal ulcer bleeding near the minor duodenal papilla due to the possibility of PD.

Keyword

Peptic ulcer; Endoscopic hemostasis; Pancreatitis

MeSH Terms

Cholangiopancreatography, Magnetic Resonance
Drainage
Duodenal Ulcer*
Endoscopy
Female
Hemorrhage*
Hemostasis, Endoscopic*
Humans
Ligation
Melena
Methods
Middle Aged
Pancreas*
Pancreatic Ducts
Pancreatitis*
Peptic Ulcer
Ulcer

Figure

• 

  Fig. 1. Endoscopy showing a small ulcer with oozing (black arrow) adjacent to the suspicious minor papilla (white arrow) on the opposite side of superior duodenal angle (A) and state of endoscopic band ligation (B).

• 

  Fig. 2. CT scan revealing diffuse swelling of the pancreas with peripancreatic fat infiltration and a small amount of fluid collection. CT, computed tomography.

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  Fig. 3. Endoscopy showing the placed band for duodenal ulcer (A) and removal of the band using endoscopic cap and forceps (B).

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  Fig. 4. Axial gadolinium-enhanced T1-weighted image (A) and MRCP image (B) showing the dorsal pancreatic duct (white arrows) directly connected to the accessory pancreatic duct, which drained into the minor ampulla. There was no communication between the ventral duct (black arrows) and the dorsal duct, but the ventral duct entered the major ampulla (A, B). MRCP, magnetic resonance cholangiopancreatography.

Reference

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