Cystic dilatation of the terminal ventral main pancreatic duct was first termed Wirsungocele
in 2004 following an incidental finding [1]. The association between Wirsungocele and recurrent acute pancreatitis was first
reported by Gupta et al. [2]. A potential etiology has been proposed involving dysfunction of the autonomic innervation
of the sphincter of Oddi, causing non-coordination and functional obstruction at the
papillary orifice, resulting in Wirsungocele [3]. However, the definite pathophysiological mechanism for formation of Wirsungocele
and the association with recurrent acute pancreatitis remain uncertain. We describe
here a case of the youngest patient diagnosed with Wirsungocele with recurrent acute
pancreatitis reported to date in the literature.
A 7-year-old boy with unremarkable antenatal and postnatal history presented with
three episodes of acute pancreatitis within 2 months. Blood tests showed a high amylase
level (peaked at 4011 U/L, reference range 29 – 118 U/L) and normal liver function
tests. Ultrasonography showed acute pancreatitis, with normal biliary tree system
and no gallstone. Magnetic resonance cholangiopancreatography revealed prominent ventral
main pancreatic duct and a cyst near the distal end of the ventral duct, compatible
with a Wirsungocele ([Fig. 1]).
Fig. 1 Magnetic resonance cholangiopancreatography showed cystic dilatation near the distal
end of the ventral duct compatible with Wirsungocele.
He underwent endoscopic retrograde cholangiopancreatography (ERCP). Pancreatogram
showed a 1.3-cm cystic dilatation of the ventral main pancreatic duct just beyond
the major papilla. Pancreatic sphincterotomy was performed, followed by dilation with
a 6-mm balloon. A 5 Fr × 5 cm, single-pigtail, pancreatic stent was inserted ([Video 1]).
Video 1 Endoscopic retrograde cholangiopancreatography for the Wirsungocele.
At the 4-week follow-up after ERCP, the patient was asymptomatic and the pancreatic
stent was removed. He remained well with no more attacks after 3 months of the follow-up.
In conclusion, this is the first video-reported case of a Wirsungocele with recurrent
acute pancreatitis that was successfully treated with endoscopic sphincterotomy and
balloon dilation.
Endoscopy_UCTN_Code_CCL_1AZ_2AL
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
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