case_images: PMC7294320_01
case_images: A 4-month-old female with emesis. Coronal T2 3D magnetic resonance cholangiopancreatography shows the pancreas divisum with the main pancreatic duct draining into the duct of Santorini (arrow). The common bile duct drains into a complex conglomeration of pancreatic head cysts (asterisk). The common bile duct is mildly prominent, and there is ascites.
case_images: JCIS-10-31-g001.jpg
case_images: PMC7294320_01_JCIS-10-31-g001.jpg
case_images: F1
case_images: Tesla scanner with 0.7 mL/kg intravenous gadoxetate disodium contrast demonstrating pancreas divisum [Figure 1] with the formation of a common channel between the distal common bile duct and the dorsal pancreatic duct of Santorini, which joined prematurely with the common bile duct into a 1.9 cm cystic malformation in the pancreatic head.
case_images: Same patient as above. Coronal T2 3D magnetic resonance cholangiopancreatography shows the 1.9 cm common cyst (arrow) that drains the duct of Santorini and the common bile duct. There are multiple cysts and ducts that extend throughout the pancreatic head with multiple connections to the duodenum (asterisk).
case_images: JCIS-10-31-g002.jpg
case_images: PMC7294320_01_JCIS-10-31-g002.jpg
case_images: F2
case_images: The cystic malformation then connected with a complex network of ducts, including one thought to represent the duct of Wirsung and other smaller cysts that drained into the duodenum [Figure 2].
case_images: Same patient as above. Axial T2 fat-saturated image shows a large pancreatic pseudocyst (asterisk), with layering debris, exerting mass effect on the pancreatic head. There is ascites.
case_images: JCIS-10-31-g003.jpg
case_images: PMC7294320_01_JCIS-10-31-g003.jpg
case_images: F3
case_images: Ascites, thought to be secondary to prior pseudocyst rupture, was also demonstrated [Figure 3].