Han X, Guo XY, Huang YS, Yu G, Lu J, Wan R, Yang LJ, Chen CY. Recurrent acute pancreatitis due to a subtle branch-duct type intraductal papillary mucinous neoplasm: A case report. World J Gastrointest Surg 2026; 18(7): 121328 [DOI: 10.4240/wjgs.v18.i7.121328]
Corresponding Author of This Article
Cong-Ying Chen, Associate Chief Physician, Department of Gastroenterology, Shanghai General Hospital, No. 100 Hai Ning Road, Shanghai 200080, China. cherrychencong@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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case-report
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Han X, Guo XY, Huang YS, Yu G, Lu J, Wan R, Yang LJ, Chen CY. Recurrent acute pancreatitis due to a subtle branch-duct type intraductal papillary mucinous neoplasm: A case report. World J Gastrointest Surg 2026; 18(7): 121328 [DOI: 10.4240/wjgs.v18.i7.121328]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 121328 Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.121328
Recurrent acute pancreatitis due to a subtle branch-duct type intraductal papillary mucinous neoplasm: A case report
Xiao Han, Xing-Ya Guo, Yin-Shi Huang, Ge Yu, Jie Lu, Rong Wan, Li-Juan Yang, Cong-Ying Chen
Xiao Han, Xing-Ya Guo, Yin-Shi Huang, Ge Yu, Jie Lu, Rong Wan, Li-Juan Yang, Cong-Ying Chen, Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
Co-corresponding authors: Li-Juan Yang and Cong-Ying Chen.
Author contributions: Han X performed the research, wrote the manuscript and edited the pictures; Han X, Huang YS, and Yu G managed the patient; Guo XY, Wan R, and Chen CY performed the endoscopic procedure; Han X, Lu J, and Yang LJ contributed to the discussion of the manuscript; Yang LJ and Chen CY designed the overall concept and outline of the manuscript, they contributed equally to this article, they are the co- corresponding authors of this manuscript; and all authors have read and approved the final manuscript.
Supported by the Shanghai Health Commission’s Clinical Research Project in the Health Industry, No. 20244Y0004; and the Clinical Research Innovation Plan of Shanghai General Hospital, No. CCTR-2025C23.
Informed consent statement: Informed consent was obtained from the patient for the publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Cong-Ying Chen, Associate Chief Physician, Department of Gastroenterology, Shanghai General Hospital, No. 100 Hai Ning Road, Shanghai 200080, China. cherrychencong@163.com
Received: March 25, 2026 Revised: April 24, 2026 Accepted: June 3, 2026 Published online: July 27, 2026 Processing time: 127 Days and 22.2 Hours
Abstract
BACKGROUND
Recurrent acute pancreatitis (RAP) poses a significant diagnostic challenge, with some cases remaining idiopathic despite extensive workup. Intraductal papillary mucinous neoplasm (IPMN) is a known precursor to pancreatic cancer, and RAP can be its initial clinical manifestation. However, diagnosing small branch-duct type IPMNs (BD-IPMNs) as the cause of RAP remains a clinical challenge, especially when standard imaging is inconclusive.
CASE SUMMARY
We report the case of a 67-year-old female with a two-year history of RAP. Despite extensive investigations, including computed tomography and magnetic resonance imaging, and even a cholecystectomy, the etiology of her pancreatitis remained elusive. The patient continued to experience recurrent episodes. A probable diagnosis was ultimately achieved during her latest admission through endoscopic ultrasound, which identified a minute (3.6 mm × 3.7 mm) BD-IPMN in the uncinate process containing a 3.3 mm hyperechoic mucus plug. Subsequently, endoscopic retrograde cholangiopancreatography with pancreatoscopy confirmed the presence of multiple mucus plugs within the cystic lesion. These were successfully removed, and a pancreatic stent was placed to ensure drainage.
CONCLUSION
Endoscopic ultrasound plays a critical role in the diagnosis of unexplained RAP. BD-IPMN can cause significant clinical symptoms through mucus production and ductal obstruction. Endoscopic retrograde cholangiopancreatography with pancreatoscopy is a valuable tool for diagnosis and immediate therapeutic intervention.
Core Tip: We report a case in which endoscopic ultrasound successfully identified a minute branch-duct type intraductal papillary mucinous neoplasm with mucus plugs as the cause of previously unexplained recurrent acute pancreatitis. The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography with pancreatoscopy. This case highlights the critical role of endoscopic ultrasound in the diagnosis of elusive recurrent pancreatitis and provides a valuable reference for its minimally invasive management, which may help improve etiological diagnosis and avoid unnecessary surgery.
