Agenesis of the Dorsal Pancreas: A Case Report and Review of the Literature
A 25-year-old woman was admitted to Chonnam National University Hospital with a four-week history of intermittent abdominal pain. She had an 11-year history of insulin-dependent diabetes mellitus. There was no previous history of peptic ulcer diseases, hepatobiliary disease, cholecystitis with gallstones or pancreatitis. On admission, her abdomen was soft and not distended, but was tender to deep palpation in the epigastric region. Physical examination was otherwise within normal limits. Laboratory evaluation revealed a white blood cell count of 5,700/mm3 (normal: 6,000-10,000), hemoglobin 11.0 g/dL (normal: 12-16), platelet count 285,000/mm3 (normal: 130,000-450,000), serum albumin 3.5 g/dL (normal: 3.0-5.0), aspartate aminotransferase 32 U/L (normal: 5-37), alanine aminotransferase 43 U/L (normal: 5-40), alkaline phosphatase 431 U/L (normal: 39-117), and γ-glutamyl transpeptidase 524 U/L (normal: 7-49). The total bilirubin was 0.38 mg/dL with 0.06 mg/dL direct fraction (normal: 0.2-1.2/0.05-0.3). Serum amylase and lipase were within normal range. An abdominal computed tomography (CT) scan showed a normal-appearing pancreatic head and complete absence of the body and tail (). Endoscopic retrograde cholangiopancreatogram (ERCP), opacified from the major papilla, showed a short duct in the uncinate process and head and the duct of Santorini draining into the minor papilla (). Abdominal magnetic resonance imaging (MRI) showed a pancreatic head, but the body and tail were not visualized (). These findings were similar to those of the CT and ERCP. The combined CT, ERCP and MRI findings were considered diagnostic of a partial agenesis of the dorsal pancreas. After symptomatic treatment, she was discharged and followed regularly.