Pancreas Divisum

Abstract

Pancreas divisum occurs when the dorsal and ventral duct systems of the pancreas fail to fuse during embryogenesis. Majority of patients with pancreas divisum are asymptomatic or can present with idiopathic pancreatitis. Diagnosis can be made by computed tomography (CT) or magnetic resonance cholangiopancreatography (MRCP) showing the dorsal duct positioned superior and anterior to the distal common bile duct and draining at the minor papilla. Patients can present with classic, incomplete, or reverse divisum depending on how much communication is between the duct systems and the features of the ventral duct. Patients who are symptomatic should receive a secretin-enhanced MRCP with or without endoscopic ultrasound to provide an enhanced visualization of the ductal system. Pancreas divisum on endoscopic retrograde cholangiopancreatography (ERCP) will show a thin, short ventral duct and a dorsal duct that fills to the tail of the pancreas during cannulation. ERCP with minor papillotomy can be used to treat pancreas divisum with severe and recurrent symptoms. For patients with minimal symptoms, treatment is conservative with analgesics, pancreatic enzymes, and a low-fat diet.