Pancreas divisum: thin-section CT.

Zeman, Robert K.; McVay, Leon V.; Silverman, P M; Cattau, Edward L.; Benjamin, Stanley B.; Fleischer, David; Garra, Brian S.; Jaffe, M. J.

doi:10.1148/radiology.169.2.3174986

Cited by 39 publications

(11 citation statements)

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“…This failure results in a short and narrow duct in the head of the pancreas that drains through the major papilla (ventral) and a longer duct that drains most of the pancreatic secretions through the minor papilla (dorsal). The increased flow caused by a fatty diet in combination with papillary stenosis may increase dorsal duct pressure and lead to the development of obstructive pancreatitis [2,3]. In our case, the first MRCP failed to fully assess the fact that the pancreatic duct had drained into the duodenum.…”

Section: Answermentioning

confidence: 73%

A rare cause of recurrent acute pancreatitis

et al. 2011

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QuestionA 72-year-old woman was admitted to our hospital complaining of severe epigastric pain radiating to her back, nausea and vomiting. She had experienced similar complaints three years earlier and had undergone a laparoscopic cholecystectomy in another hospital due to biliary acute pancreatitis. Ten months after the operation, she again suffered attacks of nausea, vomiting and mild abdominal pain. A magnetic resonance cholangiopacreatography (MRCP) was arranged by her surgeon. According to the report, findings showed normal diameter of the common bile duct with no signs of opacification and mild dilatation of the pancreatic duct without other pathological signs (Fig. 1). The patient presented on three more occasions with mild episodes of acute pancreatitis; on her last visit, she displayed abrupt epigastric pain accompanied by jaundice. The patient was readmitted to the same hospital where she underwent an endoscopic cholangiopancreatography (ERCP) with sphincterotomy (Fig. 2).During her hospitalization in our department, a complete re-evaluation was performed. No history of alcohol consumption or medication was noted. Ultrasonography of the abdomen showed slight dilatation of the pancreatic duct and no signs of opacification and dilation of the biliary tree. Laboratory work-up revealed elevated levels of serum amylase ( 3004 U/I ), while serum bilirubin, serum calcium, triglyceride, alkaline phosphatase, antinuclear antibody (ANA), anti-dsDNA and rheumatoid arthritis ( RA) factor levels were found to be normal. Tumour markers were also normal. Due to failure in

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Section: Answermentioning

confidence: 73%

A rare cause of recurrent acute pancreatitis

et al. 2011

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“…Repeated CT after resolving acute pancreatitis could improve depiction of the ductal anatomy, but we did not evaluate its usefulness in the current study. Previous studies have indicated that CT may occasionally demonstrate focal enlargement of the pancreas head without visible mass and a fatty cleft separating the dorsal and ventral pancreas in patients with pancreas divisum [13,18]; however, subsequent studies have revealed that the frequency of these findings is generally low [6,7]. Since these findings are thought to be of limited value, we did not evaluate the in the present study.…”

Section: Discussionmentioning

confidence: 84%

“…CT can also provide information regarding the ductal anatomy. Recognition of CT findings suggesting pancreas divisum can help with direct patient evaluation toward ERCP and the assessment of minor papilla function [13]. Early studies have indicated the limitations of diagnosing pancreas divisum [9,13,14], with CT techniques utilizing 5-mm collimation and 5-or 10-mm intersection gaps.…”

Section: Discussionmentioning

confidence: 99%

“…Recognition of CT findings suggesting pancreas divisum can help with direct patient evaluation toward ERCP and the assessment of minor papilla function [13]. Early studies have indicated the limitations of diagnosing pancreas divisum [9,13,14], with CT techniques utilizing 5-mm collimation and 5-or 10-mm intersection gaps. Compared with these initial studies evaluated on the hard copy, recent advances in imaging interpretation have improved our ability to visualize the small-caliber structures since the MDCT era.…”

Section: Discussionmentioning

confidence: 99%

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Detectability of pancreas divisum in patients with acute pancreatitis on multi-detector row computed tomography

et al. 2011

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The purpose of this study was to retrospectively assess the diagnostic performance of multi-detector row computed tomography (MDCT) in an evaluation of pancreas divisum using endoscopic retrograde pancreatography (ERP) as the reference standard. We analyzed 41 consecutive patients (14 cases of pancreas divisum and 27 cases of standard anatomy) who had undergone both MDCT and ERP for the evaluation of clinically diagnosed acute pancreatitis between November 2004 and June 2007. The CT reconstruction thickness and interval were both 3 mm. Two radiologists independently reviewed CT data, and the diagnostic confidence in determining the pancreatic ductal anatomy was scored using a five-point scale. CT detectability was correlated with the severity of pancreatitis and the degree of pancreatic necrosis based on the Balthazar index. With consensus, 16 of 41 cases (39.0%) were evaluated as indeterminate. Ductal anatomy was correctly diagnosed in 23 of 41 cases (56.1%). Eight of 14 cases (57.1%) were correctly diagnosed as pancreas divisum. Standard anatomy was identified in 15 of 27 cases (55.6%). The inter-observer agreement was substantial (κ = 0.71). Grade B or more pancreatitis and the presence of pancreatic necrosis significantly influenced the evaluation of ductal anatomy (p = 0.01 and p < 0.01, respectively). Pancreas divisum was correctly diagnosed in the case of grade A acute pancreatitis. The CT detectability of pancreas divisum in patients with grade B or more pancreatitis is still relatively low even in the MDCT era.

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“…Secretin-stimulated ultrasonography has also been used for diagnosis, and has been reported to predict response to therapy [15•]. Evidence for the value of CT in making the diagnosis of pancreas divisum remains scarce [16]. The role of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of pancreas divisum is being evaluated and shows promise [17,18].…”

Section: Diagnosismentioning

confidence: 99%

Pancreas divisum

Khalid

Slivka

2001

Curr Treat Options Gastro

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We offer endoscopic therapy for pancreas divisum only in patients with acute recurrent pancreatitis or chronic pancreatitis, based on studies delineated in this article, which results in response rates of 80% and 50% respectively. We do not offer endoscopic therapy for patients with chronic abdominal pain in the absence of morphologic abnormalities in the pancreatic duct or parenchyma or normal laboratory study results. It has been our experience that the success rate for endoscopic cannulation and therapy directed at the minor papilla in patients with symptomatic pancreas divisum is improved when the procedure is performed with primary intent to treat in patients who have a pre-existing diagnosis of pancreas divisum, as opposed to patients who undergo diagnostic ERCP for idiopathic acute recurrent pancreatitis and are diagnosed with pancreas divisum during the procedure. We cannulate the minor papilla with ultratapered 3-F catheters and 0.018-in soft wires. It is our opinion that minor papilla sphincterotomy offers advantages over chronic stent therapy in treating patients with pancreas divisum. Although both techniques have proven efficacy, chronic stenting requires repeated procedures and results in a high incidence of stent-induced chronic duct changes, both of which can be avoided by performing a minor papillotomy. We use an ultratapered papillotome with a 20-mm monofilament cutting wire and typically use blended current. The papillotomy is extended to ablate the mucosal mound of the minor papilla typically in a 2-o'clock direction for a distance between 4 and 8 mm, depending on the patient's anatomy. Following minor papillotomy, we place temporary 5-F pancreatic duct stents to reduce the incidence of postprocedural pancreatitis, which has been demonstrated in pancreatic duct sphincterotomy of the major papilla. These stents usually migrate out after 24 to 72 hours following the procedure. We offer surgical sphincteroplasty to patients in whom minor papillotomy cannot be performed or whose disease relapses after successful endoscopic therapy.

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Pancreas divisum: thin-section CT.

Cited by 39 publications

References 0 publications

A rare cause of recurrent acute pancreatitis

A rare cause of recurrent acute pancreatitis

Detectability of pancreas divisum in patients with acute pancreatitis on multi-detector row computed tomography

Pancreas divisum

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