We report the case of a 72-year-old man with a history of recurrent acute pancreatitis attributed to a complete pancreas divisum with pancreatic ansa, diagnosed by abdominal magnetic resonance imaging (MRI) and confirmed by endoscopic ultrasound.
The patient is admitted to our center for endoscopic treatment (sphincterotomy of the minor papilla) after two previous unsuccessful attempts using conventional ERCP.
The pancreas was initially exploded with the pancreatic echoend. The duct was successfully examined. The accessory duct described a curve (ansa) from the minor papilla to its union with the main pancreatic duct. At first, it was decided to try dilation of the papilous tissue.
The procedure began with transgastric puncture of the loop guided by echoendoscopy using a 19 G needle. The initial pancreatogram confirmed the presence of the already known anomaly.
Then, a 0.021 guide was used, with a view to later using a small-caliber sphincterotome, which advanced anterogradely through the pancreatic ansa itself until reaching the duodenal papilla minor.
The guide wire is removed and introduced in parallel to a duodenum-copy until reaching the duodenum.
Mediating a Rendez-Vous technique, the guidewire is retrieved from the duodenum, pulling it with a tweezers through the duodenum duct.
Using the guide, selective cannulation of the minor papilla is achieved.
The guide was then removed until the sphincterotomy was achieved DASH-21-480 (Cape®) and finally the guide 0.021" was advanced to the tail of the pancreas.
A sphincterotomy of the minor papilla is successfully performed. A straight pancreatic plastic stent with a 5-Fr x 5 cm double loop is placed to prevent acute pancreatitis and ensure drainage.
The prosthesis was removed two weeks after the procedure without incidents.
After this endoscopic intervention the patient has not presented new episodes of acute pancreatitis.
