Pancreas divisum

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is diagnostic. Similarly, secretin stimulated ultrasonography may positively predict the outcome of minor papilla therapy. Computed tomography is only helpful for the detection of complications. Magnetic resonance cholangiopancreatography (MRCP) is a new noninvasive diagnostic tool in development. It is accurate and might replace ERCP for diagnosis. Clinically, symptomatic patients with PD may be divided into five groups: group 1, those with minimal symptoms; group 2, those with recurrent acute pancreatitis or upper abdominal pain with no other cause; group 3, those with chronic pancreatitis; group 4, those with chronic pancreatic pain; and group 5, those with other complications. Group 1 should be treated with medical therapy alone. The response to surgical or endoscopic therapy of the minor papilla is good in group 2 (75-90%), moderate in group 3 (40-60%), and poor in group 4 (20-40%). A few patients require other forms of pancreatic surgery, such as Puestow's operation, Beger's operation, or distal pancreatectomy. With careful selection of patient and therapy, good response to the therapy can be achieved. Pancreas divisum (PD) is the most common congenital anomaly of the pancreas, with an incidence of up to 10%. Symptoms or complications developing in individuals with PD are uncommon (5% of individuals with PD). It seems unlikely that PD alone could cause obstructive pancreatitis and the presence of another factor, such as minor papilla insufficiency, is probably required for this relatively common anomaly to develop complications.