Uncommon Anatomic Variation of the Pancreatic Duct: Ansa Pancreatica

Ansa pancreatica is a rare anatomic variation of pancreatic ducts. It is a predisposing factor of recurrent pancreatitis. In this case report, we describe a case of a 24-year-old male suffering from an ansa pancreatica with a non-patent major papilla, diagnosed on magnetic resonance cholangiopancreatography (MRCP).The ansa pancreatica was revealed by an episode of acute pancreatitis attacks in chronic pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed important abrupt dilation in the main pancreatic duct with an ansa loop in the pancreatic duct in the head of the pancreas, and a sphincterotomy of the minor papilla was performed. The procedure was difficult and the placement of a long-term pancreatic stent during the ERCP was impossible, thus a surgical pancreatico-jejunostomy was proposed as a treatment of an ansa pancreatica with a non-patent major papilla.

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Anatomical Patterns of the Pancreatic Ductal System – A Cadaveric and Magnetic Resonance Cholangiopancreatography Study

Journal of Morphological Sciences ◽

10.1055/s-0039-1698371 ◽

2019 ◽

Vol 36 (04) ◽

pp. 279-285

Author(s):

Mythraeyee Prasad ◽

Sipra Rout ◽

Tharani Putta ◽

Reuben Thomas Kurien ◽

Sudipta Dhar Chowdhury ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Magnetic Resonance ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Pancreas Divisum ◽

Magnetic Resonance Cholangiopancreatography ◽

Radiological Study ◽

Ductal System ◽

Type Iii ◽

Ansa Pancreatica

Abstract Introduction Morphological variants of the pancreatobiliary system can predispose to chronic pancreatitis. The goal of the present study is to assess the prevalence of pancreatic duct patterns in the Indian population, both by cadaveric dissection and by magnetic resonance cholangiopancreatography (MRCP). Materials and Methods A total of 15 adult pancreas specimens of unknown age and gender, and 5 fetal pancreas specimens of different gestational ages with the intact second part of duodenum, were dissected by the piecemeal method. For clinical relevance, MRCP images of 103 clinically-diagnosed chronic pancreatitis patients irrespective of their etiology were obtained retrospectively from the existing database and studied. The anatomical patterns were classified as five different types based on the course of the main pancreatic duct and the accessory pancreatic duct and their openings into the duodenal wall, including variants like pancreas divisum and ansa pancreatica. Results In the cadaveric study, the main pancreatic duct was single with a straight course in 46.67% of the adult specimens, and in the MRCP study, the main pancreatic duct showed a descending course in 77.66% of the cases. The most common pattern was type III in both the cadaveric (80%) and radiological (55.33%) studies, and the accessory duct was absent on the MRCP in all type-III cases, while it ended blindly in the cadaveric specimens. Ansa pancreatica (type V) was observed in 1 adult specimen (6.7%), but not in the radiological study. Pancreas divisum (type IV) was observed in the 8 cases (7.76%) cases in the radiological study. Conclusion Knowledge of the anatomical variants of the pancreatic ductal system may be helpful for the radiologists during diagnostic and therapeutic interventional procedures.

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Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients

Radiology and Oncology ◽

10.1515/raon-2016-0041 ◽

2016 ◽

Vol 50 (4) ◽

pp. 370-377 ◽

Cited By ~ 6

Author(s):

Zehra Hilal Adibelli ◽

Mustafa Adatepe ◽

Cetin Imamoglu ◽

Ozgur Sipahi Esen ◽

Nazif Erkan ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Classification System ◽

Pancreas Divisum ◽

Anatomical Variation ◽

Anatomic Variations ◽

Predisposing Factor ◽

Rare Type ◽

Pancréas Divisum ◽

Ansa Pancreatica

Abstract Background The study was conducted to evaluate the frequencies of the anatomic variations and the gender distributions of these variations of the pancreatic duct and their relevance with the Cambridge classification system as morphological sign of chronic pancreatitis using magnetic resonance cholangiopancreatography (MRCP). Patients and methods We retrospectively reviewed 1312 consecutive patients who referred to our department for MRCP between January 2013 and August 2015. We excluded 154 patients from the study because of less than optimal results due to imaging limitations or a history of surgery on pancreas. Finally a total of 1158 patients were included in the study. Results Among the 1158 patients included in the study, 54 (4.6%) patients showed pancreas divisum, 13 patients (1.2%) were defined as ansa pancreatica. When we evaluated the course of the pancreatic duct, we found the prevalence 62.5% for descending, 30% for sigmoid, 5.5% for vertical and 2% for loop. The most commonly observed pancreatic duct configuration was Type 3 in 528 patients (45.6%) where 521 patients (45%) had Type 1 configuration. Conclusions Vertical course (p = 0.004) and Type 2 (p = 0.03) configuration of pancreatic duct were more frequent in females than males. There were no statistically significant differences between the gender for the other pancreatic duct variations such as pancreas divisium, ansa pancreatica and course types other than vertical course (p > 0.05 for all). Variants of pancreas divisum and normal pancreatic duct variants were not associated with morphologic findings of chronic pancreatitis by using the Cambridge classification system. The ansa pancreatica is a rare type of anatomical variation of the pancreatic duct, which might be considered as a predisposing factor to the onset of idiopathic pancreatitis.

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Transduodenal drainage of symptomatic walled-off pancreatic necrosis in a patient with ansa pancreatica anatomic variation

Archives of Medical Science ◽

10.5114/aoms.2017.64724 ◽

2017 ◽

Vol 1 ◽

pp. 267-269

Author(s):

Mateusz Jagielski ◽

Marian Smoczyński ◽

Beata Drelich-Góreczna ◽

Krystian Adrych

Keyword(s):

Pancreatic Necrosis ◽

Anatomic Variation ◽

Ansa Pancreatica

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Ansa pancreatica: an anatomic variation and a rare cause of acute pancreatitis

Surgical and Radiologic Anatomy ◽

10.1007/s00276-013-1103-7 ◽

2013 ◽

Vol 35 (8) ◽

pp. 745-748 ◽

Cited By ~ 10

Author(s):

Mohamed Salah Jarrar ◽

Abdelmajid Khenissi ◽

Rafik Ghrissi ◽

Fehmi Hamila ◽

Rached Letaief

Keyword(s):

Acute Pancreatitis ◽

Anatomic Variation ◽

Ansa Pancreatica

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Ansa Pancreatica, an Uncommon Cause of Acute, Recurrent Pancreatitis

Case Reports in Gastroenterology ◽

10.1159/000516686 ◽

2021 ◽

pp. 587-593

Author(s):

Danial H. Shaikh ◽

Ahmed Alemam ◽

Jennifer von Ende ◽

Haider Ghazanfar ◽

Anil Dev ◽

...

Keyword(s):

Acute Pancreatitis ◽

Pancreatic Duct ◽

Endoscopic Ultrasound ◽

Main Pancreatic Duct ◽

Recurrent Pancreatitis ◽

Recurrent Acute Pancreatitis ◽

Developmental Anomalies ◽

Anatomic Variant ◽

Minor Papilla ◽

Ansa Pancreatica

The pancreatic duct is vulnerable to developmental anomalies which may produce variations in its course and/or its configuration. Ansa pancreatica is the least common anatomic variant. It is characterized by the formation of an “S-shaped loop” from the main pancreatic duct to the minor papilla. Ansa pancreatica has been implicated as a cause of recurrent acute pancreatitis. We review existing literature on pancreatitis secondary to the ansa deformity and present a case of recurrent acute pancreatitis in a patient who was ultimately found to have the ansa deformity on endoscopic ultrasound.

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