An apparent idiopathic case of relapsing acute pancreatitis

We describe a case of relapsing acute pancreatitis apparently idiopathic in a 55-year-old man. The patient did not smoke and was a modest and irregula r drinker of wine. Endoscopic retrograde cholangiopancreatography showed an initial dilatation of secondary ducts like a chronic pancreatitis of class I of Cremer. Ultrasound and computed tomography resulted negative for panc reatic lesions. In the follow-up however, magnetic resonance cholangiopancr eatography detected the presence of an intraductal mucin-hypersecreting neo plasm, a duct-ectatic mucinous cystic tumor of the pancreas, in the uncinat e process. This is a benign lesion clearly recognized nowadays by magnetic resonance cholangiopancreatography, because this radiological technique sho ws the grape-like clusters of cystic lesions in secondary ducts communicati ng with the main duct on the same plane. The radiological picture above exc ludes a malignant lesion and a biopsy specimen is not required. Furthermore , an intraductal mucin-hypersecreting neoplasm of the pancreas does not req uire an immediate surgical resection because of its slow evolution and can be followed-up. Conversely cystoadenocarcinoma spreads in peripheral ducts and does not communicate with the Wirsung duct. It requires both surgical r esection and a biopsy specimen for histological diagnosis. In the last epis ode of acute pancreatitis, a sphincterotomy was performed at endoscopic ret rograde cholangiopancreatography and our patient had no more pain for one y ear.