P2921 - Complete Agenesis of the Dorsal Pancreas Causing Acute Pancreatitis

Jefferson Tran, , Hannah Small, RN, Bree Overman, , Skylar Sullivent, , Thomas Tran, MD
TMC, Denison, TX

Introduction: Agenesis of the dorsal pancreas (ADP) is an extremely rare congenital abnormality. Only 58 cases have been reported in the medical literature. We report a case of complete ADP leading to acute pancreatitis.

Case Description/Methods: The patient is a 63-year-old woman who presented with one week of epigastric pain radiating to her back. Pain was severe, crampy, constant, worse with meals and movements, better with rest. She had nausea but no vomiting, jaundice, icterus, dark urine, steatorrhea, fever, chills, or weight loss. She had a gallbladder and did not consume any alcohol. She denied recent trauma, insect bites, new medications, and family history of pancreatic disease. Her epigastrium was moderately tender. Her labs were significant for leukocytosis of 19,000, lipase 1505, amylase 677. Her electrolyte, renal, hepatic, lipid panels were normal. Covid-19 was negative. IgG-4 and fecal eslastase-1 levels were normal. CT scan showed acute pancreatitis in the head of the pancreas and complete agenesis of the dorsal pancreas with absence of the pancreatic body and tail. Ultrasound showed normal gallbladder and bile duct. EGD showed mild gastritis and esophagitis with a small hiatal hernia. There was no penetrating duodenal ulcer. Endoscopic ultrasound showed diffuse echogenicity of the pancreatic head and uncinate consistent with acute pancreatitis. The pancreatic duct was normal with a diameter of 2 mm. The bile duct was normal with no biliary stones or sludge. The bile duct diameter was 3 mm with no strictures. The gallbladder was normal with no stones, sludge, or wall thickening. The patient was diagnosed with acute pancreatitis due to complete ADP. She was treated with intravenous fluids and pain control with resolution of pain and nausea. Her leukocytosis was normalized. Her lipase level was normalized to 26, and amylase level was 38.

Discussion: During embryonic development, the pancreas is formed by the ventral and dorsal pancreatic buds. The ventral bud differentiates into the pancreatic head, uncinate and ventral pancreatic duct while the dorsal bud differentiates into the pancreatic body, tail, dorsal pancreatic duct, and distal pancreatic duct. ADP was first reported in 1911. In a review of the medical literature, only 58 cases were reported. Most cases were incidental findings, but several case reports found acute pancreatitis, chronic pancreatitis, and exocrine pancreatic insufficiency associated with ADP. There is no specific treatment for ADP itself.


Disclosures:


Jefferson Tran, , Hannah Small, RN, Bree Overman, , Skylar Sullivent, , Thomas Tran, MD. P2921 - Complete Agenesis of the Dorsal Pancreas Causing Acute Pancreatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.