case_images: PMC11799666_01
case_images: Computed tomographic (CT), abdominal echographic, and magnetic resonance (MR) cholangiopancreatographic findings..  (a) Contrast-enhanced CT scan of the abdomen on first admission. The pancreas was of an age-appropriate size and showed no contrast-enhanced area. Inflammation did not extend beyond the pancreas. (b) Contrast-enhanced CT of the abdomen on first admission. Edematous changes in the perirectal wall were observed (white dashed circle). (c) Abdominal echography on first admission. The pancreatic head was enlarged to 29.8 mm (white arrow). (d) Abdominal echography after relief of symptoms. The pancreatic head had shrunk to 22.8 mm, clearly smaller than in (c) (white arrow). (e) Magnetic resonance cholangiopancreatography showed that the dorsal pancreatic duct joins the main ventral pancreatic duct (white arrow).
case_images: 2185-4610-71-057-g001.jpg
case_images: PMC11799666_01_2185-4610-71-057-g001.jpg
case_images: F1
case_images: C-reactive protein (CRP) level of 1.08 mg/dL (Table 1). Contrast-enhanced computed tomography (CT) scan showed a pancreas of age-appropriate size, inflammation not extending beyond the pancreas, and no contrast-enhanced area, but edematous changes were observed in the perirectal wall (Fig. 1a, b). Abdominal echography showed an enlarged pancreatic head measuring 29.8 mm (Fig. 1c). As before, clinical symptoms subsided after she was placed on NPO status. After the symptoms became mild, abdominal echography showed no enlargement of the pancreatic head, and re-evaluation with MRCP showed delineation of the dorsal pancreatic duct and a meandering ventral pancreatic duct, which led to the diagnosis of incomplete pancreas divisum (Fig. 1d, e).
case_images: Colonoscopy and pathological findings..  (a) Colonoscopy. Circular shallow ulcers are scattered over the sigmoid colon (white arrows). (b) Colonoscopy. Circular shallow ulceration of the descending colon (white dashed circle). (c) Colonoscopy. Ulceration and deformity due to scarring suspected to be from recurrent ulceration of the inferior lip of the ileocecal valve (white arrow). (d) Upper gastrointestinal endoscopy. A bamboo sign is present from the curvature of the stomach to the cardia (white dashed circle). (e) Pathological findings from the colon (H & E stain, x200). The histopathological image depicts noncaseating granulomas (black dashed circle). (f) Pathological findings from the stomach (H & E stain, x400). The histopathological image similarly depicts noncaseating granulomas (black dashed circle).
case_images: 2185-4610-71-057-g002.jpg
case_images: PMC11799666_01_2185-4610-71-057-g002.jpg
case_images: F2
case_images: CT raised the possibility that the IBD itself might have either coexisted with or caused the AP. Colonoscopy showed an ulcer on the lower lip of the ileocecal valve and deformity due to scarring of a recurrent ulceration along with circular shallow ulcers in the descending colon, sigmoid colon, and rectum (Fig. 2a-c). Upper gastrointestinal endoscopy revealed a bamboo sign from the curvature of the stomach to the cardia (Fig. 2d), but there was no gross lesion in the duodenum. Histological examination revealed noncaseating granulomas in the colon, stomach, and duodenum (Fig. 2e, f).