Intraductal Papillary Mucinous Neoplasm Associated with Incomplete Pancreas Divisum as a Cause of Acute Recurrent Pancreatitis

Excerpt

Intraductal papillary mucinous neoplasm (IPMN) was thought to be a rare neoplasm of the exocrine pancreas, with an estimated incidence of 1 in 281,000 patients per year [1]. It is characterized by mucin production, intraductal papillary growth, and cystic dilation of the pancreatic ducts. This entity has been increasingly detected and reported in the literature recently, likely due to progress in imaging and endoscopic evaluation of the pancreas. An increase in the incidence of IPMN has also been suggested [2]. IPMN of the minor duct is rare, and only a few mucin-producing tumors have been reported associated with pancreas divisum [3‐5]. Pancreas divisum is a common congenital anomaly of the pancreas and thought to occur in approximately 10% of patients in the United States [6]. We report the first known case in the literature of IPMN affecting the minor ampulla and associated with incomplete pancreas divisum. Interestingly, in every case except one, IPMN associated with pancreas divisum mainly affected the dorsal ductal (minor) system [7]. Our patient also demonstrates the diagnostic difficulties that are present in the evaluation of IPMN, in particular, the additional complicating factors in patients with pancreas divisum and acute recurrent pancreatitis. …