pancreas divisum
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Etiology
Epidemiology
- most common congenital anatomic variant of the pancreas
Pathology
- pancreatic drainage is accomplished mainly through accessory papillae
- NOT a predisposing condition for pancreatitis in most patients
- dorsal duct obstruction may predispose to acute pancreatitis
Diagnostic procedures
- endoscopic retrograde cholangiopancreatography (ERCP)
- cannulation of dorsal duct is not as easy as ventra duct
- appearance may be confused with an obstructed main pancreatic duct secondary to a mass lesion
Radiology
- magnetic resonance cholangiopancreatography (MRCP) can detect pancreas divisum
Management
- conservative measures - observation[2]
- pancreatic enzyme therapy if evidence of pancreatic exocrine deficiency
- endoscopic or surgical intervention
- when conservative measures fail
- marked dilation of the dorsal duct
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1532
- ↑ 2.0 2.1 NEJM Knowledge+
Liao Z, Gao R, Wang W, Ye Z, Lai XW, Wang XT, Hu LH, Li ZS. A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum. Endoscopy. 2009 May;41(5):439-44. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19337962 Review.
Rustagi T, Njei B. Magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum: a systematic review and meta-analysis. Pancreas. 2014 Aug;43(6):823-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24743381 Review.
DiMagno MJ, Wamsteker EJ. Pancreas divisum. Curr Gastroenterol Rep. 2011 Apr;13(2):150-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21222060 PMCID: PMC307941 Free PMC article. Review.