Definition of Pancreas divisum
Pancreas divisum: Pancreas
divisum is a common congenital anomaly (an
anomaly that is present at birth) of the pancreatic duct(s). The
Pancreas is a deep-seated organ located behind the stomach. One of its functions
is to produce enzymes that are important for the digestion of food in the
intestine. The digestive enzymes, in the form of digestive juice, drain from the pancreas via
the pancreatic duct into the duodenum (the upper portion of the small intestine) where they aid in digesting food.
The human embryo starts life with two ducts in the pancreas; the ventral duct
and the dorsal duct. In more than 90% of the embryos, the dorsal and the ventral
ducts will fuse to form one main pancreatic duct. The main pancreatic duct will
join the common bile duct (the duct that drains bile from the gallbladder and
the liver) to form a common
bile and pancreatic duct which drains into the duodenum through the major
papilla. In approximately 10% of embryos, the dorsal and the ventral ducts fail
to fuse. Failure of the ventral and the dorsal pancreatic ducts to fuse is
called pancreas divisum (because the pancreas is drained by two ducts). In
pancreas divisum, the ventral duct drains into the major papilla, while the
dorsal duct drains into a separate minor papilla.
The majority of individuals born with pancreas divisum
experience no symptoms throughout life, will remain undiagnosed and will not
require treatment. A small number of patients with pancreas divisum will
experience repeated episodes of pancreatitis. Pancreatitis is an inflammation of
the pancreas that can cause severe abdominal pain and more severe complications.
Some patients with pancreas divisum may develop chronic abdominal pain without pancreatitis.
Doctors are not certain how pancreas divisum causes abdominal pain and
pancreatitis. One theory is that the minor papilla is too narrow to adequately
drain the digestive juices in the dorsal duct. The backup of the digestive
juices elevates the pressure in the minor duct that causes abdominal pain and
pancreatitis.
The most accurate test to diagnose pancreas divisum is ERCP, which can
demonstrate the presence of two separately draining pancreatic ducts. However,
ERCP itself sometimes can cause attacks of pancreatitis. Other tests that can
help diagnose pancreas divisum without the risk of causing pancreatitis include
endoscopic ultrasound (EUS), and MRI (magnetic resonance imaging).
Pancreas divisum without symptoms needs no treatment.
Treatment of patients with abdominal pain and recurrent pancreatitis
attributable to pancreas divisum has not been well established. Some doctors
will attempt sphincterotomy (cutting of the minor papilla during ERCP to enlarge
its opening). Others will insert a stent during ERCP into the duct to prevent
duct blockage. These procedures are not risk free. Therefore, patients with
symptomatic pancreas divisum are best
evaluated and treated by doctors in centers experienced in treating pancreatic
diseases.
Last Editorial Review: 11/14/2005
- CT Scan (Computerized Axial Tomography) - CT Scan (Computerized Axial Tomography, CAT scan) is a procedure that assists in diagnosing tumors, fractures, bony structures, and infections in the organs and tissues of the body.
- Pancreatitis - Read about acute and chronic pancreatitis; including description, causes, symptoms, how it is diagnosed, and treated.
- Ultrasound - Learn an ultrasound procedure, and conditions and diseases it assists in diagnosing and screening like tumors, cysts, heart conditions and more.
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