Meandering Main Pancreatic Duct Syndrome: a rare cause of recurrent acute pancreatitis
Bibliographic record
Abstract
Meandering main pancreatic duct syndrome (MMPD) is a rare anatomical variation in the morphology of the main pancreatic duct that occurs during embryological development.1 In rare cases (5%), the MPD can develop an abnormal curvature in the ventral duct in the head of the pancreas forming a localized spiral (loop-type) or hairpin curve (reverse Z-type).1–3 Previous studies have shown an association between the morphology of the MMPD and pancreatobiliary diseases including recurrent pancreatitis.1,2,4 We present a case of a 36-year-old male with loop-type MMPD, admitted for a second episode of idiopathic acute pancreatitis. He experienced persistent post-prandial epigastric pain and elevated lipase levels while in hospital. The patient is a non-smoker, and non-drinker, and had no family history of pancreatitis. A computed tomography scan showed mild peripancreatic fat stranding and magnetic resonance cholangiopancreatography (MRCP) identified a focal pancreatic duct stricture with dilation of the MPD proximal to the tail end of the pancreas. This led to endoscopic retrograde cholangiopancreatography (ERCP) which identified loop-type MMPD (Figure 1), and a stent was placed in the MPD. The patient improved, tolerated a full diet, and was discharged. A follow-up ERCP 58 days later with stent removal resulted in symptom resolution and no recurrence. Loop-type MMPD observed from various ERCP views. White arrows indicate the pancreatic duct: (a–c) show the loop-type MMPD; (d–e) show the stages of stent advancement; and (f) show stent deployment and drainage of contrast from the pancreatic duct. ERCP, endoscopic retrograde cholangiopancreatography; MMPD, meandering main pancreatic duct syndrome. MMPD could be a potential cause of idiopathic recurrent acute pancreatitis. Although MRCP is sensitive in visualizing the MPD, it did not detect MMPD in this case, likely due to suboptimal imaging or limited awareness of the diagnosis.1 Unlike better-known causes like pancreas divisum, MMPD remains under-recognized. Despite limited data, ERCP, and biliary stenting may help patients with MMPD experiencing recurrent pancreatitis. No funding was acquired for this case study. No conflict of interest to declare. Conflict of interest disclosure forms (ICMJE) have been collected for all co-authors and can be accessed as supplementary material here. The data underlying this article will be shared on reasonable request to the corresponding author.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.007 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".