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Ray S, Behera KK, Tripathy TP. Complete agenesis of dorsal pancreas: A rare cause of insulin-dependent diabetes mellitus. J Postgrad Med 2024; 70:113-115. [PMID: 38099610 PMCID: PMC11160984 DOI: 10.4103/jpgm.jpgm_377_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/29/2023] [Accepted: 08/08/2023] [Indexed: 04/30/2024] Open
Abstract
ABSTRACT We report a 16-year-old boy who presented with abdominal pain and severe hyperglycemia. His random blood glucose on admission was above 300 mg/dL, without ketosis. Urine examination revealed mild ketonuria. Renal function tests were normal. Antibodies to glutamate acid decarboxylase (anti-GAD) and islet tyrosine phosphatase 2 (anti-IA2) were negative. Findings on enhanced abdominal computed tomography scan were compatible with complete dorsal pancreatic agenesis. The body and tail of the pancreas were not visualized. Additionally, ectopic and malrotated left kidney was detected. Magnetic resonance cholangiopancreatography confirmed the absence of the dorsal pancreatic duct. The patient was treated with multiple subcutaneous insulin injections and attained good glycemic control. He is currently doing well on follow-up. The present case is a rare combination of complete agenesis of the dorsal pancreas with an ectopic, malrotated kidney. Clinical awareness of this rare association will help improve patient management.
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Affiliation(s)
- S Ray
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - KK Behera
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - TP Tripathy
- Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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2
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Complete agenesis of dorsal pancreas with pancreatic cyst: A case report. North Clin Istanb 2021; 8:307-309. [PMID: 34222814 PMCID: PMC8240227 DOI: 10.14744/nci.2020.24444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 01/10/2023] Open
Abstract
Agenesis of the dorsal pancreas (ADP) is extremely rare disease with no specific symptoms and there is no clear pathogenesis. Approximately half of the affected individuals develop diabetes resulting from reduced islet cell mass secondary to lack of endocrine structures. In this case, we aimed to present a 17-year-old female patient with ADP accompanied by a pancreatic cyst.
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3
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Dorsal Pancreas Agenesis in an Organ Donor: To Accept or to Discard for Transplantation? Transplant Direct 2020; 7:e646. [PMID: 33364383 PMCID: PMC7752701 DOI: 10.1097/txd.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
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4
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Valiyeva S, Romano L, Schietroma M, Carlei F, Giuliani A. Partial agenesis of dorsal pancreas. Report of two cases. Int J Surg Case Rep 2020; 77S:S17-S20. [PMID: 33168455 PMCID: PMC7876736 DOI: 10.1016/j.ijscr.2020.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022] Open
Abstract
Agenesis of the dorsal pancreas is a rare congenital anomaly. The possibility of finding this disorder is increasing with the use of advanced radiological techniques. Some patients experience no symptoms. Rarely, they may also develop pancreatic exocrine insufficiency or pancreatic adenocarcinoma. This diagnosis could be missed by US, due to difficulty on visualization of body and tail of pancreas.
Introduction Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly resulting in missing corpus and cauda of the pancreas. The possibility of finding this disorder is increasing with the use of advanced radiological techniques like CT scan or MRI. Presentation of case We reported 2 cases of a partial ADP as radiological finding: the first one was a 79-year-old asymptomatic patient who presented to perform a CT staging scan for bladder tumor, while the second case was a 73-year-old patient with obstructive jaundice and with suspected common bile duct calculi. In the second patient US, CT scan and MRI were performed, and after that also an ERCP was scheduled. Discussion The prevalence of agenesis of the dorsal pancreas is not exactly known; in the literature, only 50 cases have been reported. Its cause and pathogenesis are not fully understood. Some patients experience no symptoms, while others may develop hyperglycemia, diabetes mellitus, bile duct obstruction, abdominal pain, pancreatitis, or other conditions. Conclusion Considering that dorsal agenesis is sporadically found, often do not have related symptoms and it does not require a specific treatment, whether further examinations are needed to determine the type of agenesis remains questioned.
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Affiliation(s)
- Sayali Valiyeva
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy
| | - Lucia Romano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy.
| | - Mario Schietroma
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy
| | - Francesco Carlei
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy
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5
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Complete Agenesis of the Dorsal Pancreas as a Rare Manifestation of a Chromosomal Anomaly: A Case Report. Pancreas 2020; 49:e90-e91. [PMID: 33003097 DOI: 10.1097/mpa.0000000000001648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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6
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Mei W, Cao F, Li F. Two cases of agenesis of the dorsal pancreas and a review of the literature. BMC Gastroenterol 2020; 20:94. [PMID: 32252649 PMCID: PMC7137410 DOI: 10.1186/s12876-020-01245-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/27/2020] [Indexed: 11/21/2022] Open
Abstract
Background Agenesis of the dorsal pancreas (ADP) is a very rare disease with no specific symptoms, and the pathogenesis is not clear. Some patients will be accompanied by other diseases, such as pancreatic tumor or pancreatitis. But most cases are very atypical and difficult to distinguish. Some syndromes of pancreatic exocrine insufficiency are common in patients with ADP. Here, we report two cases of ADP and summarize the clinical features, diagnosis, and treatment of ADP. Case presentation Case A is a 65-year-old Chinese woman who presented with abdominal pain accompanied by nausea, bloating and acid reflux. The enhanced abdominal CT scan found nothing meaningful except the absence of the body and tail of the pancreas. The diagnosis was considered as gastrointestinal dysfunction cause by exocrine pancreatic insufficiency and recovered after symptomatic treatment. Case B is a 61-year-old Chinese woman who presented with abdominal pain accompanied by fever, vomiting and bloating. The abdominal CT showed multiple stones in the gallbladder, and the body and tail of the patient’s pancreas were absent. She was diagnosed with cholelithiasis and recovered after laparoscopic cholecystectomy. Conclusion Agenesis of the dorsal pancreas (ADP) is a rare congenital disease with an unclear pathogenesis that presents multiple symptoms. It should be considered when the patients have non-specific, persistent and unexplained symptoms such as bloating or uncontrolled blood sugar. Imaging examination is helpful for diagnosis. And it does not require surgical intervention unless it accompanies other diseases, EPI need to be considered when the non-specific gastrointestinal symptoms appear.
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Affiliation(s)
- Wentong Mei
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Beijing, 100053, China. .,Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China.
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7
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Kumar CB, Simon B, Simon E. An unusual case of steatorrhea. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2020. [DOI: 10.4103/jcrsm.jcrsm_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Salman R, Barakat A, Berjawi G. Dorsal pancreatic agenesis in newly diagnosed type one diabetes mellitus: case report and review of literature. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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9
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A Cienfuegos J, Rotellar F, Salguero J, Benito A, Solórzano JL, Sangro B. Agenesis of the dorsal pancreas: systematic review of a clinical challenge. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:479-84. [PMID: 27468966 DOI: 10.17235/reed.2016.4474/2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Agenesis of the dorsal pancreas is a rare malformation. Since 1911 and until 2008, 53 cases have been reported. Several authors have recently described the association of this anomaly with neoplasia of the ventral pancreas, thus we performed a systematic review of the literature from 2008 to 2015. METHODS A systematic review of the MedLine and ISI Web of Science Databases from 2008 until 2015 was carried out, and 30 articles which met the inclusion criteria were identified that included a total of 53 patients: 7 children and 46 adults. CONCLUSIONS Although dorsal pancreatic agenesis is a rare malformation, given its association with non-alcoholic pancreatitis and neoplasia of the residual pancreas, physicians should maintain an expectant attitude.
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Affiliation(s)
| | | | - Joseba Salguero
- Cirugía General y Digestiva, Clinica Universidad de Navarra, España
| | | | | | - Bruno Sangro
- Hepatología, Clinica Universidad de Navarra, España
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10
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Kabnurkar R, Rokade ML, Bandekar K, Kamat N. Incidentally Detected Agenesis of Dorsal Pancreas on PET/CT: Case Report and Review of Literature. Indian J Nucl Med 2017; 32:33-35. [PMID: 28242982 PMCID: PMC5317067 DOI: 10.4103/0972-3919.198471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Agenesis of Dorsal Pancreas (ADP) is a rare congenital anomaly characterized by the absence of body and tail of pancreas. We report a case of incidentally detected ADP on Contrast Enhanced Computed Tomography (CECT) component of Fluorodeoxyglucose Positron Emission Tomography (FDG PET/CT) in a treated case of carcinoma (Ca) tongue with suspected local recurrence. Dependent Intestine Sign, hallmark of ADP on CECT imaging was noted in our patient.
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Affiliation(s)
| | - M L Rokade
- Department of Radiology, Jupiter Hospital, Thane, India
| | | | - Nikhil Kamat
- Department of Radiology, Jupiter Hospital, Thane, India
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11
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Saikaly E, El Asmar A, Abi Fadel F, Aoun M, El Rassi Z. Agenesis of the dorsal pancreas associated with mucinous adenocarcinoma and cystic teratoma: a case report and literature review. Clin Case Rep 2017; 5:175-181. [PMID: 28174646 PMCID: PMC5290498 DOI: 10.1002/ccr3.797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 11/18/2016] [Accepted: 12/08/2016] [Indexed: 11/07/2022] Open
Abstract
Dorsal agenesis of the pancreas is a rare congenital anomaly. Fifty‐eight cases were reported from 1913 till 2015, nine of which were associated with tumors. We present the 10th case, the first to be associated with pancreatic mucinous adenocarcinoma and cystic teratoma, successfully managed by Whipple procedure and total pancreatectomy.
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Affiliation(s)
- Elias Saikaly
- Faculty of MedicineSaint Georges Hospital University Medical CenterUniversity of BalamandBeirutLebanon
| | - Antoine El Asmar
- Faculty of MedicineSaint Georges Hospital University Medical CenterUniversity of BalamandBeirutLebanon
| | - Fahim Abi Fadel
- Faculty of MedicineSaint Georges Hospital University Medical CenterUniversity of BalamandBeirutLebanon
| | - Mona Aoun
- Faculty of MedicineSaint Georges Hospital University Medical CenterUniversity of BalamandBeirutLebanon
| | - Ziad El Rassi
- General and Digestive SurgeryOncologic SurgeryFaculty of MedicineSaint Georges Hospital University Medical CenterUniversity of BalamandBeirutLebanon
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12
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Kumar R, Vyas K, Agrahari N, Kundu J, Jaiswal G. Complete agenesis of the dorsal pancreas: Case report with imaging findings and review of the literature. Malawi Med J 2016; 27:73-4. [PMID: 26405517 DOI: 10.4314/mmj.v27i2.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R Kumar
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
| | - K Vyas
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
| | - N Agrahari
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
| | - J Kundu
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
| | - G Jaiswal
- Department of Radiodiagnosis, Geetanjali Medical College & Hospital, Geetanjali University, Udaipur, India
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13
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Paiella S, De Pastena M, Esposito A, Salvia R, Morigi C, Bassi C. Selective agenesis of pancreatic isthmus parenchyma with preservation of main pancreatic duct continuity, a very rare entity: Case report. Int J Surg Case Rep 2014; 6C:169-71. [PMID: 25544484 PMCID: PMC4347963 DOI: 10.1016/j.ijscr.2014.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/18/2014] [Indexed: 12/03/2022] Open
Abstract
Pancreatic congenital anomalies are not infrequent. A rare selective agenesis of pancreatic parenchyma is presented. Neoplastic lesions should always been considered in case of pancreatic congenital anomalies.
Context Agenesis of the dorsal pancreas is a rare anomaly, mostly associated with other medical conditions. It may be complicated with pancreatic neoplasms. Case report We report the case of a 51-year-old male with selective agenesis of pancreatic isthmus with preservation of main pancreatic duct and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with suspicious features of the pancreas. Conclusion This is probably the first report of isolated agenesis of pancreatic isthmus with conservation of main pancreatic duct.
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Affiliation(s)
- Salvatore Paiella
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy.
| | - Matteo De Pastena
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| | - Alessandro Esposito
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| | - Roberto Salvia
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| | - Consuelo Morigi
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
| | - Claudio Bassi
- University of Verona, Department of General Surgery B, Istituto del Pancreas, Verona, Italy
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14
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Gagnière J, Dupré A, Ines DD, Tixier L, Pezet D, Buc E. Giant mucinous cystic adenoma with pancreatic atrophy mimicking dorsal agenesis of the pancreas. World J Gastrointest Surg 2014; 6:42-46. [PMID: 24672649 PMCID: PMC3964414 DOI: 10.4240/wjgs.v6.i3.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/15/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Mucinous cystic adenoma (MCA) of the pancreas is a rare benign cystic tumor with ovarian-like stroma and lack of communication with the pancreatic ductal system. The ovarian tissue is incorporated from the left gonad within the dorsal pancreas during embryogenesis. Consequently, congenital dorsal agenesis of the pancreas (DAP) cannot be associated with MCA. We report the case of a giant MCA associated with atrophy of the dorsal pancreas mimicking complete DAP. Pancreato-magnetic resonance imaging failed to identify the dorsal pancreas but the absence of diabetes mellitus and compression of the splenic vein with major tributaries rectified the diagnosis of secondary atrophy of the distal pancreas. Unusual proximal location of the cyst in the pancreas may have induced chronic obstruction of both the dorsal pancreatic duct and the splenic vein, with secondary atrophy of the distal pancreas.
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15
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Bento A, Baptista H, Oliveira F. Malformações congênitas do pâncreas: um caso clínico. Rev Assoc Med Bras (1992) 2013. [DOI: 10.1590/s0104-42302013000100009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
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16
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Jeong JH, Kim GH, Song GA, Lee DG, Moon JY, Cheong JH, Kim S. Polysplenia syndrome with congenital agenesis of dorsal pancreas presenting as acute pancreatitis and the role of endoscopic ultrasonography in its diagnosis. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 60:47-51. [PMID: 22832800 DOI: 10.4166/kjg.2012.60.1.47] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 49-year-old female was admitted to our hospital for acute pancreatitis. The abdomen CT scan incidentally showed midline liver with hepatomegaly, centrally located gallbladder, pancreas truncation, right sided small bowel, left sided large bowel, interruption of the inferior vena cava with azygos continuation, preduodenal portal vein, and multiple spleens in the left upper quadrant. In MRCP, the head of pancreas was enlarged and short main pancreatic duct without accessory duct was showed. EUS revealed enlarged ventral pancreas with a main pancreatic duct of normal caliber, absence of the accessory pancreatic duct and the dorsal pancreas. She was diagnosed as polysplenia syndrome with agenesis of dorsal pancreas. It is a rare congenital anomaly frequently associated with various visceral anomalies including multiple spleens, impaired visceral lateralization, congenital heart diseases, gastrointestinal abnormalities and azygos continuation of the inferior vena cava. We report a case of polysplenia syndrome with agenesis of dorsal pancreas presenting acute pancreatitis.
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Affiliation(s)
- Jae Hoon Jeong
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
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17
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Abstract
Morphogenesis of the pancreas is a complex process; nevertheless, congenital anomalies are rare. At embryogenesis, the pancreas develops from the endoderm-lined dorsal and ventral buds of the duodenum. The ventral bud gives rise to the lower head and uncinate process of the pancreas; whereas, the dorsal bud gives rise to the upper head, isthmus, body, and tail of the pancreas. Rarely, developmental failure of the dorsal pancreatic bud at embryogenesis results in the agenesis of the dorsal pancreas--neck, body, and tail. Even rarer is the association of pancreatic tumors with agenesis of the dorsal pancreas. In addition to citing our case, we provide a comprehensive review on agenesis of the dorsal pancreas and its association with pancreatic tumors.
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Schnedl WJ, Piswanger-Soelkner C, Wallner SJ, Reittner P, Krause R, Lipp RW, Hohmeier HE. Agenesis of the dorsal pancreas and associated diseases. Dig Dis Sci 2009; 54:481-7. [PMID: 18618254 DOI: 10.1007/s10620-008-0370-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 06/03/2008] [Indexed: 12/13/2022]
Abstract
BACKGROUND Agenesis of the dorsal pancreas is a very rare congenital pancreatic malformation and is associated with some other diseases. METHODS A PubMed search revealed 53 cases of agenesis of the dorsal pancreas. RESULTS In 28 patients with this congenital malformation hyperglycemia was demonstrated, 27 had abdominal pain, 16 had pancreatitis, 14 had an enlarged or prominent pancreatic head visible on computed tomography, and in a few cases, polysplenia, which may occur with various congenital anomalies of visceral organs, was described. CONCLUSIONS Difficulties involved in obtaining a firm diagnosis have led to a variety of terms being used to describe this congenital disease. Diagnosis of agenesis of the dorsal pancreas is inconclusive without demonstration of the absence of the dorsal pancreatic duct. Here we describe the embryological development of the pancreas, the so-far known cases of agenesis of the dorsal pancreas with associated medical problems, and the diagnostic measures to find the right conclusions.
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Affiliation(s)
- Wolfgang J Schnedl
- Department of Internal Medicine, Medical University, Auenbruggerplatz 15, A-8036, Graz, Austria.
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19
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Haldorsen IS, Vesterhus M, Raeder H, Jensen DK, Søvik O, Molven A, Njølstad PR. Lack of pancreatic body and tail in HNF1B mutation carriers. Diabet Med 2008; 25:782-7. [PMID: 18644064 DOI: 10.1111/j.1464-5491.2008.02460.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Hepatocyte nuclear factor 1B (HNF1B) gene mutation carriers have a systemic disease characterized by congenital malformations in the urogenital tract, diabetes mellitus of maturity-onset diabetes of the young type and dysfunction of the liver and exocrine pancreas. We aimed to investigate pancreatic structure and exocrine function in carriers of HNF1B mutations. METHODS We studied five subjects from two families with the previously reported mutation R137_K161del and the novel mutation F148L in HNF1B. All patients underwent computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP). We measured faecal elastase and serum vitamins D and E. RESULTS One of the mutation carriers reported abdominal symptoms. All five subjects had faecal elastase deficiency, three had vitamin D deficiency and two had vitamin E deficiency. Neither CT nor MRCP depicted tissue corresponding to the pancreatic body and tail in the five mutation carriers, indicating agenesis of the dorsal pancreas. The head of the pancreas was slightly atrophic but had normal X-ray attenuation at CT in all patients. CONCLUSIONS Agenesis of the pancreatic body and tail and pancreatic exocrine dysfunction are parts of the phenotype in HNF1B mutation carriers. This strengthens the evidence for a critical role of HNF1B in development and differentiation of at least the dorsal pancreas.
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Affiliation(s)
- I S Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
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20
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Doxey BW, Jackson WD, Adler DG. A unique presentation: dorsal agenesis of the pancreas manifesting as pancreatic exocrine insufficiency in the absence of diabetes mellitus in an 8-year-old boy. Dig Dis Sci 2008; 53:2005-6. [PMID: 18060496 DOI: 10.1007/s10620-007-0094-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 10/27/2007] [Indexed: 12/09/2022]
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21
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Joo YE, Kang HC, Kim HS, Choi SK, Rew JS, Chung MY, Kim SJ. Agenesis of the dorsal pancreas: a case report and review of the literature. Korean J Intern Med 2006; 21:236-9. [PMID: 17249505 PMCID: PMC3891028 DOI: 10.3904/kjim.2006.21.4.236] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Partial or complete agenesis of the dorsal pancreas is a rare congenital anomaly that results from the embryological failure of the dorsal pancreatic bud to form the body and tail of the pancreas. To date, four cases have been reported in Korea. We report an additional case; a 25-year-old woman presented with diabetes mellitus and abdominal pain. Abdominal computed tomography (CT) revealed a normal-appearing pancreatic head, but the body and tail were not visualized. Endoscopic cholangiopancreatogram (ERCP) revealed a short pancreatic duct in the uncinate process and the head and the duct of Santorini draining into the minor papilla. Abdominal magnetic resonance imaging (MRI) findings were similar to the CT and ERCP results. The patient was diagnosed with partial agenesis of the dorsal pancreas by CT, ERCP and MRI.
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Affiliation(s)
- Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
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22
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Güçlü M, Serin E, Ulucan S, Kul K, Ozer B, Gümürdülü Y, Pata C, Coşar A, Gür G, Boyacioğlu S. Agenesis of the dorsal pancreas in a patient with recurrent acute pancreatitis: case report and review. Gastrointest Endosc 2004; 60:472-5. [PMID: 15332050 DOI: 10.1016/s0016-5107(04)01733-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mustafa Güçlü
- Department of Gastroenterology, Başkent University, Adana Teaching and Medical Research Center, Sk. No:6 Yüreğir, Adana, Turkey
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Abstract
The liver is mainly responsible for maintaining normal concentrations of blood glucose by its ability to store glucose as glycogen and to produce glucose from glycogen breakdown or gluconeogenic precursors. During the last decade, new techniques have made it possible to gain further insight into the turnover of hepatic glucose and glycogen in humans. Hepatic glycogen varies from approximately 200 to approximately 450 mM between overnight fasted and postprandial conditions. Patients with type-1 diabetes (T1DM), type 2 diabetes (T2DM) or partial agenesis of the pancreas exhibit increased endogenous glucose production and synthesize only 25-45% of hepatic glycogen compared with non-diabetic humans. This defect can be partly restored in T1DM by combined long- and short-term optimized treatment with insulin. In T2DM, increased gluconeogenesis was identified as the main cause of elevated glucose production and fasting hyperglycaemia. These patients also exhibit augmented intracellular lipid accumulation which could hint at a link between deranged glucose and lipid metabolism in insulin-resistant states.
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Affiliation(s)
- Michael Roden
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Schnedl WJ, Lipp RW. Can human pancreatic beta-cells regenerate in vivo? Diabetes Res Clin Pract 2003; 61:77-8; author reply 78-9. [PMID: 12849926 DOI: 10.1016/s0168-8227(03)00068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stingl H, Schnedl WJ, Krssak M, Bernroider E, Bischof MG, Lahousen T, Pacini G, Roden M. Reduction of hepatic glycogen synthesis and breakdown in patients with agenesis of the dorsal pancreas. J Clin Endocrinol Metab 2002; 87:4678-85. [PMID: 12364458 DOI: 10.1210/jc.2002-020036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
In a family with agenesis of the dorsal pancreas only the mother presents with insulin-dependent diabetes mellitus, whereas her sons are glucose tolerant. We examined whether metabolic defects can be detected early in this disease. Plasma glucose profiles were obtained from patients with dorsal pancreas agenesis and from matched healthy subjects. Hepatic glycogen synthesis and breakdown were determined from the time course of glycogen concentrations using noninvasive (13)C nuclear magnetic resonance spectroscopy. Gluconeogenesis was calculated from the difference between glucose production (measured with D-[6,6-(2)H(2)]glucose) and glycogen breakdown. Frequently sampled iv glucose tolerance tests were performed to assess insulin secretion and sensitivity. The mean plasma glucose level was higher (12.9 +/- 0.4 vs. 5.9 +/- 0.1 mmol/liter), whereas the peak plasma insulin level was lower (236 vs. 397 +/- 23 pmol/liter) in the diabetic mother than in her nondiabetic sons and healthy subjects. In all patients, however, glycogen synthesis and breakdown were reduced by approximately 55% (P < 0.05) and 40% (P < 0.02), respectively. Gluconeogenesis (6.8 +/- 0.8 vs. 4.2 +/- 0.3 micro mol/kg.min; P < 0.05) and hepatic insulin clearance (6.8 +/- 1.3 vs. 2.8 +/- 1.0 ml/kg.min) were increased in all patients. In conclusion, patients with complete agenesis of the dorsal pancreas exhibit marked defects in hepatic glycogen metabolism, which are present even in the nondiabetic offspring.
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Affiliation(s)
- Harald Stingl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, University of Vienna, A-1090 Vienna, Austria
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Schnedl WJ, Reisinger EC, Lipp RW, Uggowitzer M, Mischinger HJ, Fickert P, Krejs GJ. Biliary obstruction due to duodenojejunal intussusception in Peutz-Jeghers syndrome. J Clin Gastroenterol 1996; 23:220-3. [PMID: 8899507 DOI: 10.1097/00004836-199610000-00014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report a 58-year-old woman with Peutz-Jeghers syndrome and episodic abdominal pain over a period of 30 years, possibly due to recurrent duodenojejunal intussusception, which eventually led to complete duodenal and biliary obstruction and associated mesothelioma.
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Affiliation(s)
- W J Schnedl
- Department of Internal Medicine, Karl Franzens University, Graz, Austria
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