Diagnostic Significance of Pancreas Divisum in Early Life

Abstract

Pancreas divisum (PD) is a congenital anomaly in which the ventral and dorsal pancreatic ducts fails to fuse in the early fetal period. This anomaly has been known to rarely cause recurrent pancreatitis and to require surgical intervention. With the recent advances in image diagnostic procedures, an increasing incidence of this anomaly has been recognized in the pediatric age group. Seven cases of PD were encountered in our institution between 1978 and 1998. Six were female and one was male, with a mean age of 8 years. All cases were diagnosed to have PD by endoscopic retrograde pancreatography (ERCP) or operative pancreatography. One case (14.3%) had PD associated with a bout of pancreatitis and was operated on by transduodenal papilloplasty, but recurrent bouts of pancreatitis led to the performance of longitudinal pancreaticojejunostomy (Puestow procedure). Six cases (85.7%) were found to have PD as an incidental finding during operation for congenital dilatation of the bile ducts (CDBD), however, 2 cases (33.3%) out of the 6 developed pancreatitis in a later stage and ERCP was effective in their follow-up assessment. One benefited from conservative treatment while the other needed transduodenal papilloplasty along with pancreatoductoplasty. Imaging procedures (ERCP or operative pancreatography) revealed complete PD in 3 cases (42.9%), and incomplete PD in 4 cases (57.1%), however, there was no clinically significant difference between the groups.

Recent advances in pathophysiology and surgical treatment of congenital dilatation of the bile duct

“…Recently, magnetic resonance cholangiopancreatography (MRCP) has been recognized for its usefulness in delineating the pancreatic and biliary tracts and their junction. This technique may prove of great usefulness in determining whether surgery is indicated in patients in whom dilatation of the bile duct is relatively slight in degree despite PBM being suspected; the technique may also be useful in patients who are suspected of having a concurrent malformation of the pancreatic duct i.e., pancreas divisum 21…”

Recurrent acute pancreatitis caused by malrotation of the intestine and effective treatment with laparoscopic Ladd’s procedure

“…The etiology of pancreatitis in children is varied, and the recurrent form is mostly associated with congenital etiology, such as dilatation of the bile duct combined with pancreaticobiliary maljunction, pancreas divisum, intrapancreatic duplication of the intestine, and so on [1][2][3][4][5]. However, malrotation of the intestine has been reported as a very rare cause of recurrent pancreatitis [6].…”

Pancreas Divisum in Children and Duodenum-Preserving Resection of the Pancreatic Head

“…However, due to recurrence of pancreatitis 1 year later, the Puestow's procedure was performed. 20 Schneider et al report 28 patients treated surgically for symptomatic PD. The group included one child, a 12-year-old boy, who underwent segmental resection performed 2.3 years after sphincteroplasty of the minor papilla.…”

“…The scarce published cases of children with PD indicate that sphincteroplasty may not be sufficient in preventing pancreatitis. 20,21 The Puestow's procedure is preferred to the DPRPH in the presence of a dilated pancreatic duct; otherwise, it is surgically challenging and has lower chance of success. As pancreatic duct dilation was not noted in our patient during ERCP, DPRPH was indicated.…”