Pancreas divisum: a reemerging risk factor for pancreatic diseases

Abstract

Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. The attention towards the PD has grown significantly since there are reports that this condition may cause acute relapsing pancreatitis, chronic pancreatitis and chronic abdominal pain syndrome. Furthermore, over the years, there have been multiple reports of PD associated with different types of tumors. There is evidence that PD can be associated with pancreatic tumors (up to 12.5% of cases). The golden standard for diagnosing PD is endoscopic retrograde cholangiopancreatography, but since it is an invasive procedure magnetic resonance cholangiopancreatography with secretin is a good alternative. In case the patient is symptomatic, endoscopic or surgical treatment should be performed. This review describes the key points of the pathophysiology, diagnostic modalities, risks of pancreatitis and tumors, as well as treatment options of PD.

Pâncreas divisum: relato de caso

“…O pâncreas é formado pela fusão dos botões dorsal e ventral, que se desenvolvem a partir do intestino anterior embriológico, sendo o pâncreas divisum, justamente, uma falha desse processo. É a anomalia congênita do pâncreas mais comum 1,2,3,5,9 .…”

“…Com incidência de aproximadamente 4,5% no mundo, pâncreas divisum (PD) é a anomalia anatômica considerada a mais comum do ducto pancreático 1,2,3,5 . Ocasionada pela falha na fusão dos ductos ventral e dorsal do pâncreas embrionário, ocorre por volta da 7ª semana da vida intrauterina 1,5,8 .…”

“…Existem três variantes conhecidas dessa anomalia: PD completa, quadro mais comum, responsável por 70% dos casos, nesta, o sistema do ducto ventral se abre na papila maior enquanto o ducto do sistema dorsal se abre na papila menor sem que haja comunicação entre os dois ductos; PD incompleta, presente entre 5 a 6% dos casos, similar à completa, contudo, apresenta uma pequena comunicação entre os dois ductos pancreáticos; PD reversa, presente em cerca de 20 a 25% dos casos, o ducto de Wirsung não é presente; Por fim, também existe a pseudo PD, na qual ocorre uma obstrução do ducto de Wirsung em um pâncreas normal 1,3 .…”

Idiopathic recurrent acute pancreatitis in the context of pancreas divisum: A case report

“…This condition may occur in approximately 10% of the population [5] . In such cases, the dorsal duct plays the main role in drainage of pancreatic secretions through minor papilla and a small ventral duct opens to the major papilla [6] . Most individuals with pancreas divisum remain asymptomatic but in about 5% of cases, it can be the hidden reason for idiopathic recurrent acute pancreatitis.…”

Clip-assisted minor pancreatic duct cannulation to manage pancreatic duct leak

“…Pancreas divisum is present in 10% of patients 1 . Diagnosis during ERCP occurs in 0.47% to 2.3% of cases 2 . Early recognition of pancreas divisum is very important to avoid adverse events, namely, acute pancreatitis or duct trauma and rupture.…”