Meandering Main Pancreatic Duct: A Rare Cause of Idiopathic Recurrent Acute Pancreatitis.

The meandering main pancreatic duct (MMPD) is a rare developmental variant associated with idiopathic recurrent acute pancreatitis (IRAP) due to potential ductal hypertension. Although acute evaluation by magnetic resonance cholangiopancreatography (MRCP) is not routinely recommended for acute pancreatitis, it becomes essential in unexplained cases. We report a case of a 19-year-old male who presented with acute epigastric pain and recurrent pancreatitis, marked by elevated serum lipase and a bulky pancreas on CT. MRCP revealed an MMPD with a unique N-shape, without ductal dilatation or intraductal calcification and gallstones or other identifiable causes, suggesting it as the etiology of his IRAP. He was managed conservatively, with resolution of symptoms, and advised to avoid potential risk factors and report any recurrence. Some cases of recurrent acute pancreatitis have no identifiable cause, but anatomical variations of the pancreatic duct, such as an MMPD, are thought to play a contributory role, although the underlying mechanism is not fully understood. Early recognition of such anomalies through imaging, such as MRCP, is important to identify the underlying causes of IRAP and guide appropriate long-term management.