Pancreas divisum: opinio divisa

Quest, L; Lombard, Martin

doi:10.1136/gut.47.3.317

Cited by 66 publications

(41 citation statements)

References 25 publications

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“…Pancreas divisum is a relatively common pancreatic congenital anomaly, with a prevalence of 5-10% (Agha and Williams, 1987). It occurs when the ventral and dorsal ducts do not fuse, resulting in the persistence of the dorsal accessory pancreatic duct (Klein and Affronti, 2004;Quest and Lombard, 2000). Annular pancreas, on the other hand, is a rare congenital defect that occurs when the ventral pancreas forms a complete ring around the duodenum, causing an obstruction of the duodenum (Jimenez et al, 2004;Ladd and Madura, 2001).…”

Section: Introductionmentioning

confidence: 99%

The tetraspanin Tm4sf3 is localized to the ventral pancreas and regulates fusion of the dorsal and ventral pancreatic buds

et al. 2009

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During embryogenesis, the pancreas develops from separate dorsal and ventral buds, which fuse to form the mature pancreas. Little is known about the functional differences between these two buds or the relative contribution of cells derived from each region to the pancreas after fusion. To follow the fate of dorsal or ventral bud derived cells in the pancreas after fusion, we produced chimeric Elas-GFP transgenic/wild-type embryos in which either dorsal or ventral pancreatic bud cells expressed GFP. We found that ventral pancreatic cells migrate extensively into the dorsal pancreas after fusion, whereas the converse does not occur. Moreover, we found that annular pancreatic tissue is composed exclusively of ventral pancreas-derived cells. To identify ventral pancreas-specific genes that may play a role in pancreatic bud fusion, we isolated individual dorsal and ventral pancreatic buds, prior to fusion, from NF38/39 Xenopus laevis tadpoles and compared their gene expression profiles (NF refers to the specific stage of Xenopus development). As a result of this screen, we have identified several new ventral pancreas-specific genes, all of which are expressed in the same location within the ventral pancreas at the junction where the two ventral pancreatic buds fuse. Morpholinomediated knockdown of one of these ventral-specific genes, transmembrane 4 superfamily member 3 (tm4sf3), inhibited dorsalventral pancreatic bud fusion, as well as acinar cell differentiation. Conversely, overexpression of tm4sf3 promoted development of annular pancreas. Our results are the first to define molecular and behavioral differences between the dorsal and ventral pancreas, and suggest an unexpected role for the ventral pancreas in pancreatic bud fusion.

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Section: Introductionmentioning

confidence: 99%

The tetraspanin Tm4sf3 is localized to the ventral pancreas and regulates fusion of the dorsal and ventral pancreatic buds

et al. 2009

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“…4 However, no clear association exists between pancreas divisum and chronic pancreatitis. 7 Patients with pancreas divisum who are otherwise well (e.g., those whose pancreas divisum is discovered during imaging done for another purpose) can be reassured that they have only a 5%-10% lifetime risk of developing pancreatitis, 8 which is similar to the risk in the general population. …”

Section: Figurementioning

confidence: 87%

Pancreas divisum: a cause of idiopathic acute pancreatitis

Tarabain²

2009

Canadian Medical Association Journal

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A previously healthy 23-year-old woman presented to hospital with 2 months of intermittent dyspepsia following meals and acute-onset epigastric pain, nausea and vomiting. Based on the results of laboratory investigations (lipase > 1900 [normal < 286] U/L), acute pancreatitis was diagnosed. It was treated conservatively with analgesics and intravenous hydration. The results of other laboratory tests, including those for amylase, leukocytes and creatinine, were within normal limits. No obvious reversible causes of pancreatitis were initially identified. The patient reported consuming alcohol rarely. Ultrasonography of the abdomen ruled out gallstones. A computed tomography (CT) scan of her abdomen and pelvis showed that her pancreas had a relatively normal appearance; however, assessment was limited because of minimal intra-abdominal fat in her upper abdomen in the region of the pancreatic head. After 2 days, the patient's pain had improved but her lipase level remained above 500 U/L. The patient's abdominal pain and lipase levels (829 U/L) increased after she resumed eating solid foods.Ultrasonography performed 21 days after admission showed gallbladder "sludge" with no evidence of stones.Laparoscopic cholecystectomy was performed. The results of tests for autoimmune pancreatitis (antinuclear antibodies and IgG subtypes) were negative. However, the patient had persistent abdominal pain and an elevated lipase level above 1000 U/L. Twenty-eight days after admission, she underwent magnetic resonance cholangiopancreatography, which showed pancreas divisum. Following endoscopic retrograde cholangiopancreatography (Figure 1), a sphincterotomy on the major papilla was performed with no noteworthy clinical improvement. Six weeks later, endoscopic retrograde cholangiopancreatography was repeated, with sphincterotomy of the minor papilla and placement of a stent. The patient's pain resolved, and her lipase levels returned to normal within 14 days. Discussion Anatomy and epidemiologyIn over 90% of healthy people, the dorsal and ventral endodermal pancreatic buds fuse to form the adult pancreas. However, in about 10% of the population, fusion does not occur, resulting in pancreas divisum (Figure 2), which is the most common congenital ductal anomaly of the pancreas. 1 The classic anatomy of pancreas divisum consists of a small ventral duct, which drains through the larger major papilla, and the larger dorsal duct, which drains through the smaller minor papilla. 2,3In patients with a large dorsal duct, the majority of the pancreatic secretions (up to 2000 mL daily) pass through this duct.2 Pancreas divisum through the minor papilla (instead of the major papilla) can result in inadequate drainage and pain Key points• Pancreas divisum is a congenital anomaly that occurs in about 10% of the population and is a potentially treatable cause of acute pancreatitis.• The lifetime risk of pancreatitis for patients with pancreas divisum (5%-10%) is similar to risk in the general population.• Pancreas divisum should be considered in pa...

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“…Therefore, the drainage of these glands are made separately in the duodenum. 2 Patients with mild symptoms can be managed conservatively. However, those with recurrent acute pancreatitis, chronic pancreatitis or pancreatic-type abdominal pain may require treatment that focuses on decompression and drainage of the dorsal duct, performed endoscopically or surgically.…”

Section: Discussionmentioning

confidence: 99%

“…1 It is usually asymptomatic, therefore the treatment (endoscopic or surgical) is indicated in symptomatic patients after thorough investigation and ruling out other causes of pancreatic type abdominal pain and acute pancreatitis. 2,3 Our objective is to demonstrate a novel technique of EUSguided access to dorsal pancreatic duct in a patient with pancreas divisum with previous history of acute pancreatitis…”

Section: Introductionmentioning

confidence: 99%