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EUS diagnosis and endoscopic treatment of Wirsungocele: A a rare cause of pancreatitis


 Gastroenterology and Digestive Endoscopy Unit, ICCS, Milan, Italy

Date of Submission01-Sep-2020
Date of Acceptance27-Oct-2020
Date of Web Publication20-Jan-2021

Correspondence Address:
Nicolò Mezzina,
Gastroenterology and Digestive Endoscopy Unit, ICCS, via Jommelli 17, 20131 Milan
Italy
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_77_20

PMID: 33473046



How to cite this URL:
Mezzina N, Quarta Colosso BM, Beretta P. EUS diagnosis and endoscopic treatment of Wirsungocele: A a rare cause of pancreatitis. Endosc Ultrasound [Epub ahead of print] [cited 2021 Apr 12]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=307451

Cystic dilation of the terminal main pancreatic duct – named Wirsungocele – is a rare condition which has to be taken into account among the potential causes of pancreatitis. Since the first description in 2004,[1] the association between Wirsungocele and recurrent pancreatitis has been reported in literature,[2] and endoscopic therapy has been proposed to reduce the risk of recurrent pancreatitis. Recently, Cheung et al. reported the case of a pediatric patient with recurrent acute pancreatitis which was successfully treated with sphincterotomy and balloon dilation.[3]

A 77-year-old male patient was admitted to our emergency department for severe abdominal pain. His past medical history was unremarkable. Blood tests showed high amylase level (>4000 U/L, normal range 28–100), normal bilirubin, and slightly elevated liver enzymes (aspartate aminotransferase 160, alanine aminotransferase 70); abdominal ultrasound was consistent with mild edematous pancreatitis, without gross evidence of biliary stones. Accordingly, a EUS was planned to rule out microlithiasis or small focal lesions.

Endoscopically, the major papilla showed a slightly protruding appearance. At EUS, a saccular dilation of the terminal part of the main pancreatic duct, about 8 mm in diameter, without upstream dilation of the pancreatic duct [Figure 1]a and [Figure 1]b, was evident. The common bile duct was completely free of abnormalities, as it was the pancreatic parenchyma [Figure 1]. The patient subsequently underwent a magnetic resonance cholangiopancreatography, which confirmed the EUS findings. Endoscopic retrograde cholangiopancreatography with pancreatic sphincterotomy was performed, followed by placement of a pancreatic plastic stent (5 Fr × 5 cm). After 1 month, the patient did not report any other episode of abdominal pain [Figure 2]a & [Figure 2]b.
Figure 1: EUS showing a saccular dilation (*) of the terminal pancreatic duct in the region of the major papilla, without upstream dilation and a normal biliary duct.

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Figure 2: (a) Magnetic resonance cholangiopancreatography showing the Wirsungocele. (b) Endoscopic appearance of the Wirsungocele after sphincterotomy

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Abu-Hamda EM, Baron TH. Cystic dilatation of the intraduodenal portion of the duct of Wirsung (Wirsungocele). Gastrointest Endosc 2004;59:745-7.  Back to cited text no. 1
    
2.
Gupta R, Lakhtakia S, Tandan M, et al. Recurrent acute pancreatitis and Wirsungocele. A case report and review of literature. JOP 2008;9:531-3.  Back to cited text no. 2
    
3.
Cheung RL, Chan SM, Yip HC, et al. Endoscopic management of Wirsungocele with recurrent acute pancreatitis. Endoscopy 2020;52:E162-3.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

 
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