Pancreatic Divisum

What is Pancreatic Divisum?
Pancreatic divisum is a congenital variant of the pancreas that is present in approximately 10% of the population. It is the most common congenital pancreatic anomaly. Pancreatic divisum occurs when fusion of the ductal system of the pancreas is incomplete, resulting in an accessory duct (of Santorini). In classic pancreatic divisum, the small duct drains through the larger papilla (opening into the small intestine), and the larger duct drains through the smaller papilla.

Symptoms
Symptoms of pancreatic divisum include upper abdominal pain, nausea, vomiting, weight loss, and sometimes diarrhea. Symptoms are often increased after eating, and sometimes the pain radiates to the back or shoulder.

Many patients with pancreatic divisum do not have symptoms. Approximately 5% of patients with pancreatic divisum develop symptoms from it. Symptoms are attributed to inadequate ductal drainage, which results in ductal distention, pain, and sometimes pancreatitis.  Some patients develop recurrent bouts of pancreatitis, which is a painful inflammation of the pancreas. Approximately one half of patients with pancreatic divisum have elevated spincter of oddi pressures, which compounds the symptoms.

Diagnosis
Pancreatic divisum is best diagnosed with MRCP or endoscopic ultrasound. Blood tests are often performed during episodes of symptoms to evaluate for pancreatitis.

Treatment
In patients who are asymptomatic, it is recommended to follow a low-fat diet and avoid excessive alcohol intake to help protect against developing future symptoms. In patients with mild symptoms, including mild or infrequent episodes of abdominal pain, treatment is symptomatic. This includes low-fat diet and medications to improve symptoms during bouts.

Patients with significant, recurrent, or chronic pancreatic-type pain sometimes require ERCP with sphincterotomy of the minor papilla. This is done to help improve ductal drainage. Dr.Ahmed is one of very few physicians who perform ERCP for pancreatic divisum. Call to schedule an evaluation with Dr.Ahmed if you are concerned that you may have pancreatic divisum, or other pancreatic disorder.