Pancreas Divisum – more than a rare cause of recurrent pancreatitis

Pancreas divisum (PD) is the most common congenital variant of pancreatic duct anatomy. It occurs in approximately 6%-10% of healthy individuals. In embryonic period, during second month of gestation, the ventral and dorsal pancreatic ducts fail to fuse. This failure forces the dorsal pancreatic duct and minor papilla to become the major drainage channel for pancreatic exocrine secretion. Only a minority of patients with PD develop pancreatitis. The objective was to give an example of causal relationship between PD and pancreatitis. It has been the subject of controversy, although most authors agree that PD is a definite cause in a subgroup of patients. A 13-year-old boy was admitted to our institution for recurrent acute pancreatitis. In the period of one year, he was admitted twice for recurrent acute pancreatitis. On admission, no symptoms were reported, except for minor epigastric tenderness. Family history concerning pancreatitis and other gastrointestinal diseases was unremarkable. Clinical examination, laboratory and radiology diagnosis were performed. Laboratory blood test results were within the standard range. Magnetic resonance cholangiopancreatography demonstrated separation of the pancreatic ducts, i.e. pancreas divisum. In the perisplenic area, residues of earlier inflammation were noted. We were able to confirm the causal relationship between PD and pancreatitis. Treatment consists of endoscopic interventions with prophylactic temporary stenting or surgical care. The probable factor that promotes recurrent acute pancreatitis in pancreas divisum is relative stenosis of the minor duodenal papilla.

Keywords: PANCREAS – diagnosis, radiography, surgery; PANCREATITIS, CHRONIC – complications, surgery; ADOLESCENT;
Category: Case report
Volume: Vol. 56, No 1, january - march 2012
Authors: B. Kvenić, D. Divković, D. Miletić, M. Peršić
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