Ansa pancreatica: A rare etiology behind acute pancreatitis: Features and management

ABSTRACT Purpose: Ansa pancreatica is an embryologic malformation where the accessory pancreatic duct is obliterated and replaced instead by a loop merging from the main duct. It is associated with recurrent acute pancreatitis. Case presentation: 1st case A 47-year-old male patient with a history of former alcoholism presented in the last three years five episodes of acute pancreatitis. He presented for a 6th episode. An MRCP was practiced revealing an ansa pancreatica. The patient undergoes an endoscopic sphincterotomy. 2nd case It is a 74-year-old woman patient, who presented for a second episode of acute pancreatitis. The investigations did not reveal a gallstone disease or any metabolic abnormalities. An MRCP was performed showing an ansa pancreatica. 3rd case A 27-year-old male admitted for acute pancreatitis. Initial abdominal ultrasound revealed gallbladder sludge along with a dilated common bile duct (CBD). The patient underwent a cholecystectomy with cholangiography. The cholangiography revealed an ansa pancreatica. The post-operative recovery was uneventful. Discussion: Ansa pancreatica, is an embryological malformation consisting of the accessory pancreatic duct obliteration, near its junction with the common duct. This portion is replaced by an S-shaped loop joining the minor papilla. That can lead to clinical manifestations, particularly acute pancreatitis. Sphincterotomy targeting the minor papilla could improve symptoms and reduce pancreatitis recurrence. In case of failure, endoscopic ligation of the ansa deformity represents a good alternative. Conclusion: Through these cases, we tried to illustrate different scenarios in which we discovered an ansa pancreatica and the management of such anatomic variance. Highlights