Dorsal pancreatic agenesis revealed by acute biliary pancreatitis in a postpartum woman with gestational diabetes: a case report

Dorsal pancreatic agenesis is an exceptionally rare congenital anomaly involving the partial or complete absence of the pancreatic body and tail. Metabolic dysfunction, including impaired glucose tolerance and insulin-dependent diabetes, is frequently reported; however, the relationship between dorsal pancreatic agenesis and gestational diabetes mellitus has been reported only sporadically. The objective of this report is to present a rare case of dorsal pancreatic agenesis revealed by acute biliary pancreatitis and recurrent gestational diabetes mellitus and to review the relevant literature concerning its metabolic and clinical implications. We report the case of a postpartum woman in her early 30s who presented with acute biliary pancreatitis. Imaging revealed complete agenesis of the pancreatic body and tail, with preservation of the pancreatic head derived from the ventral bud. She had a history of recurrent gestational diabetes, raising the possibility that pregnancy-associated insulin resistance had unmasked a compensated beta-cell deficit due to dorsal pancreatic agenesis. The patient underwent an uncomplicated laparoscopic cholecystectomy with symptom resolution. This case highlights three clinically significant observations: (1) recurrent gestational diabetes mellitus may represent an early clinical clue to reduced pancreatic endocrine reserve in dorsal pancreatic agenesis; (2) acute biliary pancreatitis can incidentally reveal congenital pancreatic anomalies; and (3) structural pancreatic abnormalities should be considered in patients with atypical or recurrent gestational diabetes mellitus. The association between dorsal pancreatic agenesis and gestational diabetes has been reported, albeit rarely, but the interaction between recurrent gestational diabetes mellitus, obesity, and reduced pancreatic endocrine reserve remains insufficiently characterised.