Question
A 34-year-old woman comes to the emergency department because of a 2-hour history of abdominal pain, nausea, and vomiting that began an hour after she finished lunch. Examination shows abdominal guarding and rigidity; bowel sounds are reduced. Magnetic resonance cholangiopancreatography shows the dorsal pancreatic duct draining into the minor papilla and a separate smaller duct draining into the major papilla. The spleen is located anterior to the left kidney. A disruption of which of the following embryological processes is the most likely cause of this patient’s imaging findings?
| A. |
Fusion of visceral and parietal peritoneum
|
| B. |
Rotation of the midgut
|
| C. |
Fusion of the pancreatic buds
|
| D. |
Rotation of the ventral splenic bud
|
Show Answer
[ads id=”53026″]
|
Correct Answer � C
Explanation
|
|
Answer C) Fusion of the pancreatic buds
Explanation: The dorsal pancreatic duct normally drains into the major duodenal papilla.
-
Fusion of the dorsal and ventral pancreatic buds normally occurs during the 8th week of embryological development.
-
Subsequently, the distal portion of the dorsal pancreatic duct fuses with the ventral pancreatic duct, which drains into the major duodenal papilla via the Ampulla of Vater.
-
The proximal portion of the dorsal pancreatic duct would degenerate or persist as an accessory pancreatic duct that drains into the minor duodenal papilla. If the pancreatic buds fail to fuse (pancreas divisum), the dorsal and ventral pancreatic duct would drain separately into the duodenum with the dorsal pancreatic duct draining via the minor duodenal papilla, as seen on this patient’s MRCP.
-
Most individuals with pancreas divisum are asymptomatic, but a small percentage will present with chronic abdominal pain or pancreatitis, as is the case here.
Like this:
Like Loading...
