Pancreas divisum

Annular pancreas, pancreas divisum, pancreatic hypoplasia and agenesis, heterotopic pancreas Inherited syndromes affecting the pancreas Cystic fibrosis... 

Structural Gallstone disease, sphincter of Oddi dysfunction, pancreas divisum, pancreatic tumors... 

Obstructive Pancreas divisum, pancreatic duct obstruction... 

Deviation of this process will result in different congenital anomalies of the pancreas. For instance, in some patients, the pancreatic ducts will not connect. In these patients the duct of Santorini will drain the main portion of the pancreas into the papilla minor, while the main pancreatic duct of Wirsung will drain only the posterior and inferior portion of the head and uncinate process in the duodenum through the papilla major after joining the common bile duct. Tbis congenital anomaly is called a pancreas divisum (Fig. 4.14). 

Fig. 4.14. Scheme of the anatomy and relationship of the pancreatic in pancreas divisum. Note the reversal of the relative size of the ducts. (Drawing adapted from F.N. Netter 1964] The Netter Collection of Medical Illustrations-Digestive System-part III)... 

Pancreas divisum is the most common congenital anomaly of the pancreatic duct system. It arises from an incomplete fusion of the dorsal and ventral pancreatic ducts. The incidence of pancreas divisum at autopsy ranges between 4.7% and 11%, but in patients with unexplained pancreatitis the incidence can be as high as 25.6%. Multiple attacks of pancre-... 

ERCP is a very useful tool for the evaluation of pancreas divisum. It will show a short duct of Wir-sung, limited to the head of the pancreas, without filling of the main pancreatic duct. The accessory papilla can be cannulated and the accessory duct of Santorini draining the residual part of the gland will be found. 

The ductal abnormality in pancreas divisum may be diagnosed by MRCP often only after secretin stimulation (S-MRCP) (Fig. 4.16b,c). The duct of Santorini may be enlarged and the pancreas may demonstrate the characteristic features of pancreatitis. However, the detection of pancreas divisum at S-MRCP might be more difficult when stones or strictures are present in the ventral or dorsal pancreatic ducts (Manfredi et al. 2000). 

MRCP is a very useful imaging tool used to identify possible etiologies of pancreatitis such as abnormal union of the pancreatobiliary junction, choledochal cyst, or pancreas divisum, in patients with unknown cause (Arcement et al. 2001 Hirohashi et al. 1997). 

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