Diagnostic aspects of incomplete pancreas divisum

Tulassay, Z.; Papp, J.; Farkas, I

doi:10.1016/s0016-5107(86)71934-2

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…Complete pancreas divisum has been reported as a relatively rare condition with the frequency of 0.5-11%, and in our study, the frequency was 2.1% 16,20. Incomplete pancreas divisum is less frequent than complete pancreas divisum, the frequency is approximately 0.13-0.9%, and in our study, it was 1.2%, which is slightly higher than previous reports 21,22. Duplication anomalies are also uncommon, and Uomo et al23 reported the frequency to be approximately 4.6%, which is similar to the 5.5% detected in our study.…”

Section: Discussioncontrasting

confidence: 51%

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

et al. 2006

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The aims of this study were to identify the morphological diversities and anatomical variations of pancreatic ductal system and to define the relationships between pancreatic ductal systems, pancreaticobiliary diseases, and procedure-related complications, including post-ERCP pancreatitis. This study included 582 patients in whom both pancreatic duct (PD) and common bile duct were clearly visible by ERCP. PD systems were categorized into four types according to the relationship between common bile duct and PD. In types A and B, Wirsung duct formed the main PD. In type C, Wirsung duct did not form the main PD. If PD system did not fall into any of these three types, it was categorized as type D. The distribution of types among pancreatic ducts examined was as follows: type A: 491 cases (84.4%), type B: 56 cases (9.6%), type C: 20 cases (3.4%), and type D: 15 cases (2.6%). The anomalous anatomic variations of PD systems were divided into migration, fusion, and duplication anomalies. PD anomalies were noted in 51 patients, of which 19 (3.3%) were fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum), and 32 (5.5%) were duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. However, post-ERCP hyperamylasemia was more frequently found in types C (41.7%), D (50%) and A (19.8%) than in type B (9.4%). In summary, whether Wirsung duct forms the main PD and the presence or absence of the opening of the Santorini duct are both important factors in determining the development of pancreatitis and hyperamylasemia after ERCP.

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Section: Discussioncontrasting

confidence: 51%

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

et al. 2006

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“…This can lead to opacification of the dorsal system during injection of contrast in the ventral duct during Endoscopic Retrograde Pancreatography (ERP). The prevalence of this variant is about 15%[16, 17, 18]. [Figure 2C, Figure 4]…”

Section: Epidemiology Embryogenesis Subtypesmentioning

confidence: 99%

Identification and management of pancreas divisum

Gutta

Fogel

Sherman

2019

Expert Review of Gastroenterology & Hepatology

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Pancreas divisum, the most common congenital malformation of the pancreas, occurs due to a failure of fusion of the ductal systems of the dorsal and ventral pancreatic buds in the seventh week of intra-uterine life. This leads to a dominant dorsal pancreatic duct draining though the minor papilla and a small ventral pancreatic duct draining through the major papilla. The prevalence in western populations is about 10% and more than 95% of these patients are without pancreatic symptoms, with the anomaly found incidentally on abdominal imaging for an unrelated indication. The etiological role and clinical significance of pancreas divisum in relation to pancreatic disease has not yet been clearly defined, but may predispose to pancreatic disease in co-existence with other factors. Secretin-enhanced Magnetic Resonance Cholangiopancreatography is the non-invasive imaging modality of choice to identify pancreas divisum. Patients may be offered minor papilla therapy when they present with recurrent acute pancreatitis, severe acute pancreatitis and can be considered for therapy in the setting of chronic pancreatitis and chronic abdominal pain of pancreatic origin. Minor papilla endotherapy (sphincterotomy and/or stenting) via Endoscopic Retrograde Cholangiopancreatography and minor papilla surgical therapy have comparable outcomes with endotherapy typically considered first-line due to a favorable adverse event profile. The response to therapy is variable with maximal benefit seen in patients with recurrent acute pancreatitis and least with chronic pancreatic-type abdominal pain. Data supporting either therapy are of low quality as they are predominantly retrospective with a sub-optimal follow up period. Surgical options including a pancreatojejunostomy (Puestow or Frey procedure) or a total pancreatectomy with auto-islet cell transplantation may be considered in a subset of patients.

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“…Incomplete pancreas divisum is a pancreatic anomaly with inadequate communication between the ventral and dorsal pancreatic ducts (Tulassay et al 1986;Sugawa et al 1987). Under the concept of branch fusion (Hirooka et al 1994), we evaluated the pancreatographic findings in incomplete pancreas divisum cases and confirmed branch fusion via detailed pancreatogram measurements.…”

Section: Figmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Complete pancreas divisum is defined as a completely separate pancreatic duct system in a grossly undivided gland. Incomplete pancreas divisum is a pancreatic anomaly with inadequate communication between the ventral and dorsal pancreatic duct (Tulassay et al 1986;Sugawa et al 1987). Based on the embryology and radiological findings, Hirooka et al (1994) proposed the concept of branch fusion between the ventral and dorsal pancreatic ducts; this concept had previously been confirmed pathologically (Suda et al 1991a,b).…”

Section: Introductionmentioning

confidence: 99%

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Pancreatographic investigation of pancreatic duct system and pancreaticobiliary malformation

Kamisawa¹,

Okamoto

2008

Journal of Anatomy

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To clarify the anatomy of the pancreatic duct system and to investigate its embryology, we reviewed 256 pancreatograms with normal pancreatic head, 81 with pancreas divisum and 74 with pancreaticobiliary maljunction. Accessory pancreatograms were divided into two patterns. The long-type accessory pancreatic duct forms a straight line and joins the main pancreatic duct at the neck portion of the pancreas. The short-type accessory pancreatic duct joins the main pancreatic duct near its first inferior branch. The short-type accessory pancreatic duct is less likely to have a long inferior branch arising from the accessory pancreatic duct. The length of the accessory pancreatic duct from the orifice to the first long inferior branch was similar in the short-and long-type accessory pancreatic ducts. The first long inferior branch from the long-type accessory pancreatic duct passes though the main pancreatic duct near the origin of the inferior branch from the main pancreatic duct. Immunohistochemically, in the short-type accessory pancreatic duct, the main pancreatic duct between the junction with the short-type accessory pancreatic duct and the neck portion was located in the ventral pancreas. The long-type accessory pancreatic duct represents a continuation of the main duct of the dorsal pancreatic bud. The short-type accessory pancreatic duct is probably formed by the proximal main duct of the dorsal pancreatic bud and its long inferior branch.

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Diagnostic aspects of incomplete pancreas divisum

Cited by 7 publications

References 3 publications

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

Identification and management of pancreas divisum

Pancreatographic investigation of pancreatic duct system and pancreaticobiliary malformation

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