Nhân một trường hợp chẩn đoán và điều trị tụy đôi, ống tụy phụ có sỏi, giản dạng nang

Diagnosis and treatment pancreas divisum together calculi and cystic dilatation of the accessory duct

SAMMARY:

A patient, 46 year old, female, with abdominal pain, was admitted to Hospital of Hanoi medical university. Divisum pancreas was diagnosed in MR image and in operation, the accessory pancreatic duct was largely dilated which formed a cyst in the pancreatic head with some calculi inside.

Divisum pancreas is a common congenital abnormaly of the pancreatic ducts. The human embryo starts life with two ducts in the pancreas; the ventral duct and the dorsal duct. In more than 90% of the embryos, the dorsal and the ventral ducts will fuse to form one main pancreatic duct. The main pancreatic duct will join the commom bile duct and drains into the duodenum through the major papilla. In approximately 10% of embryos, the dorsal and the ventral ducts fail to fuse. Failure of the ventral and the dorsal pancreatic ducts to fuse is called pancreas divisum. In pancreas divisum, the ventral duct drains into the major papilla, while the dorsal duct drains into a separate minor papilla. In patients with divisum pancreas, the majority of the pancreatic secretions pass through dorsal duct and the minor papilla (instead of the major papilla) that can result in inadequate drainage and pain caused by obstruction. And this obstruction may be the cause of acute pancreatitis, chronic pancreatitis and pancreatic lithiasis