Pancreas: Pancreatic Divisum

Pancreatic Divisum

General

  • Ventral & Dorsal Buds Fail to Fuse
  • Most Common Pancreatic Developmental Anomaly
    • Prevalence: 10%

Types

  • Complete/Classic (70%)
    • Small Ventral Duct (Wirsung) Drains to Major Papilla
    • Large Dorsal Duct (Santorini) Drains to Minor Papilla
  • Incomplete
    • Only A Small Branch of the Ventral Duct (Santorini) Communicates to Dorsal Duct (Wirsung)
  • Reverse
    • Isolated Small Segment of Dorsal Pancreas

Presentation

  • Abdominal Pain & Pancreatitis (From Inadequate Drainage Through Minor Papilla)
  • Most (95%) Are Asymptomatic

Diagnosis

  • Dx: CT or MRCP
    • Gold-Standard: Secretin-Enhanced MRCP
      • Secretin Improves Visualization of the Pancreatic Duct

Treatment

  • Asymptomatic: None
  • Mild Symptoms: Conservative (Low-Fat Diet & Pain Control)
  • Severe/Recurrent Symptoms: ERCP (Minor Papilla Sphincterotomy)
    • Avoid Stenting – High Complication Rates
    • If Fails: Surgery (Duodenotomy & Minor Papilla Sphincteroplasty)

Ventral & Dorsal Buds Fail to Fuse 1

Pancreatic Divisum on MRCP 2

References

  1. Tadokoro H, Takase M, Nobukawa B. Development and congenital anomalies of the pancreas. Anat Res Int. 2011;2011:351217. (License: CC BY-3.0)
  2. Otsuka S, Sugiura T, Uesaka K. Acute obstructive pancreatitis after pancreas-sparing total duodenectomy in a patient with pancreas divisum: a case report. Surg Case Rep. 2016 Dec;2(1):126. (License: CC BY-4.0)