Pancreas Divisum is a Probable Cause of Acute Pancreatitis: A Report of 137 Cases

The incidence of pancreas divisum (PD) was evaluated in a retrospective series of 1,825 successful consecutive ERCPs. One hundred thirtyseven pancreas divisums (7.5%) were found in 80 males and 57 females at a mean age of 49.2 years. The ventral ducts were visualized in 82.5% and the dorsal ducts in 74.1% of attempted cannulations of the minor papilla. Pancreas divisum was significantly more frequent in patients presenting with acute idiopathic pancreatitis (50.0%) or acute biliary pancreatitis (23.7%) than in controls or in the general population. This difference was not found in acute pancreatitis due to other etiologies. Acute pancreatitis associated with PD is generally recurrent, is not severe, but may be complicated by necrotic pseudocysts. The frequency of PD was also significantly increased in patients with gallbladder stones but not with common bile duct stones. In other pathological groups-chronic pancreatitis and pancreatic cancer-the frequency of pancreas divisum was not statistically different from that observed in controls and/or in the general population. We conclude that on a statistical basis, PD is a probable cause of acute pancreatitis, especially in its idiopathic recurrent variety, and that its frequency is increased in patients with gallbladder stones.

[1]  J. Vij,et al.  Pancreaticobiliary ductal union in biliary diseases. An endoscopic retrograde cholangiopancreatographic study. , 1989, Gastroenterology.

[2]  M. Delhaye,et al.  Pancreas divisum: controversial clinical significance. , 1988, Digestive diseases.

[3]  C. Sugawa,et al.  Pancreas divisum: is it a normal anatomic variant? , 1987, American journal of surgery.

[4]  M. Delhaye,et al.  Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography. , 1985, Gastroenterology.

[5]  A. Warshaw,et al.  Objective evaluation of ampullary stenosis with ultrasonography and pancreatic stimulation. , 1985, American journal of surgery.

[6]  P. Cotton,et al.  Resection for Pancreatitis in Patients with Pancreas Divisum , 1984, Annals of surgery.

[7]  A. Warshaw,et al.  The Cause and Treatment of Pancreatitis Associated with Pancreas Divisum , 1983, Annals of surgery.

[8]  A. Monaco,et al.  Pancreas divisum. Results of surgical intervention. , 1983, American journal of surgery.

[9]  F. Saibil,et al.  Treatment of pancreatitis associated with pancreas divisum by dorsal duct sphincterotomy alone. , 1982, Canadian journal of surgery. Journal canadien de chirurgie.

[10]  J. Sahel,et al.  Clinico-pathological conditions associated with pancreas divisum. , 1982, Digestion.

[11]  A. Mulley,et al.  Association of pancreas divisum and pancreatitis, and its treatment by sphincteroplasty of the accessory ampulla. , 1981, Gastroenterology.

[12]  P. Salmon,et al.  The clinical relevance of isolated ventral pancreas , 1981, The British journal of surgery.

[13]  Z. Tulassay,et al.  New clinical aspects of pancreas divisum. , 1980, Gastrointestinal endoscopy.

[14]  P. Cotton.  Congenital anomaly of pancreas divisum as cause of obstructive pain and pancreatitis. , 1980, Gut.

[15]  A. Axon,et al.  Clinical relevance of an unfused pancreatic duct system. , 1979, Gut.

[16]  J. Gregg.  Pancreas divisum: its association with pancreatitis. , 1977, American journal of surgery.

[17]  J. Belber,et al.  Fusion anomalies of the pancreatic ductal system differentiation from pathologic states. , 1977, Radiology.

[18]  L. Demling,et al.  The clinical significance of the pancreas divisum. , 1976, Gastrointestinal endoscopy.

[19]  M. Classen,et al.  Variations and Anomalies of the Papilla of Vater, the Pancreas and the Biliary Duct System , 1974 .

[20]  J. Langman,et al.  An anatomical‐radiological study on the pancreatic duct pattern in man , 1961, The Anatomical record.

[21]  D. Ziegler,et al.  A study of the pancreatic duct system in man by the use of vinyl acetate casts of postmortem preparations. , 1960, Surgery, gynecology & obstetrics.

[22]  M. Birnstingl.  A study of pancreatography , 1959, The British journal of surgery.

[23]  E. Millbourn.  On the excretory ducts of the pancreas in man, with special reference to their relations to each other, to the common bile duct and to the duodenum. , 1950, Acta anatomica.

[24]  W. Baldwin.  An adult human pancreas showing an embryological condition , 1910 .