A Case of Agenesis of the Dorsal Pancreas Associated with Polysplenia that was Initially Treated as Type 2 Diabetes for 10 Years

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  • Fujii Wataru
    Department of Internal Medicine, Takikawa Municipal Hospital
  • Makita Minoru
    Department of Medicine II, Hokkaido University Graduate School of Medicine
  • Koyanagawa Naohide
    Department of Medicine II, Hokkaido University Graduate School of Medicine
  • Takano Yoshinari
    Department of Medicine II, Hokkaido University Graduate School of Medicine
  • Kitao Naoyuki
    Department of Medicine II, Hokkaido University Graduate School of Medicine
  • Miya Aika
    Department of Medicine II, Hokkaido University Graduate School of Medicine
  • Kon Yujiro
    Department of Internal Medicine, Takikawa Municipal Hospital
  • Miyashita Keiichi
    Department of Internal Medicine, Takikawa Municipal Hospital
  • Tsutsumi Akihito
    Department of Internal Medicine, Takikawa Municipal Hospital
  • Kuroda Yoshihiko
    Department of Internal Medicine, Takikawa Municipal Hospital

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Other Title
  • 10年間2型糖尿病として治療されていた多脾症に合併した膵体尾部欠損症の1例
  • 症例報告 10年間2型糖尿病として治療されていた多脾症に合併した膵体尾部欠損症の1例
  • ショウレイ ホウコク 10ネンカン 2ガタ トウニョウビョウ ト シテ チリョウ サレテ イタ タヒショウ ニ ガッペイ シタ スイタイ ビブ ケッソンショウ ノ 1レイ

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Abstract

We herein report the case of a 55-year-old woman with polysplenia and a short pancreas. She had received pacemaker therapy for sick sinus syndrome at 35 years of age and was diagnosed with type 2 diabetes at 44 years of age. Therapy with medical nutrition and the administration of oral agents allowed her to achieve adequate glycemic control initially; however, her glycemic control gradually became unsatisfactory. In February 2012, she was admitted to our hospital due to epigastric pain, nausea and vomiting. A gastrointestinal X-ray showed intestinal obstruction, while a computed tomography scan disclosed polysplenia, interruption of the vena cava with azygos continuation, a right bilobed lung, the absence of the body or tail of the pancreas and a pancreatic volume that was approximately 50 %of normal. Therefore, a deficiency in insulin secretion resulting from agenesis of the dorsal pancreas was the leading cause of the patient's diabetes. Near normal glycemic control was achieved with multiple daily insulin injections. Polysplenia syndrome is a rare congenital disorder associated with cardiac and visceral anomalies. Only 5-10 %of polysplenia patients without cardiac involvement reach adulthood. The present patient was diagnosed with polysplenia after a 10-year history of diabetes. We suggest that more studies, including imaging examinations, are needed in cases of diabetes.

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