Pancreas Divisum
Pancreas divisum results when the back of the pancreas drained by one pancreatic tube and the front of the pancreas drained by another tube fail to join before joining with the main bile tube. The chances of someone having pancreas divisum are believed to be 5% to 10%, but drainage is normal in most of these people without any site of blockage.
It is not known how many patients with this problem later get chronic recurrent (repeating episodes of) pancreatitis because symptoms may start anytime from early childhood to mid adulthood. ERCP usually shows a short tube in the front of the pancreas (Figure 1). There are many patterns of this problem, and pancreatitis does not result unless there is either a narrowing of the junction with the intestine or a narrowing somewhere else in the drainage tube within the pancreas, usually at the junction point between the front and back tubes. Occasional patients may develop an abnormal “cyst-like” swelling in the center. For patients who experience repeat episodes of pancreatitis, increasing the size of the opening between one or both tubes into the intestine and removing the gallbladder is recommended (many patients develop gallstones). The pancreatic tubes are rarely swollen, even in symptomatic patients. Approximately 75% of patients have a good result after operation. SUGGESTED READING Neblett WW, O’Neill JA: Surgical management of recurrent pancreatitis in children with pancreas divisum. Ann Surg 231:899-908, 2000. |
Figure 1: Pancreas divisum seen on ERCP. Only a small pancreas duct (tube) is seen (arrows) because the main pancreas tube which drains 90% of the pancreas is separate. |
Article and graphics adapted from O'Neill: Principles of Pediatric Surgery. © 2003, Elsevier.