IS Case 322: Pancreatic divisum

Jerry Lee, MD


Imaging Sciences URMC 2009
Publication Date: 2009-09-14

History

Patient is a 62-year-old female with elevated alkaline phosphatase and clinical suspicion for choledocholithiasis.

Findings

Non-fusion of the main and accessory pancreatic ducts. The main pancreatic duct drains via the minor papilla and a small accessory pancreatic duct drains via the major papilla with the common bile duct.

Diagnosis

Pancreatic divisum

Discussion

Pancreatic divisum is the most common congenital anomaly of the pancreas occurring in approximately 7% of autopsy series. It is caused by failure of the ducts of the dorsal and ventral buds to fuse during embryological development. In classical pancreas divisum, the small ventral duct, or duct of Wirsung, drains via the major papilla and the large dorsal duct or duct of Santorini, drains via the minor papilla. This is usually an incidental finding and most individuals are asymptomatic, however, a small number of patients with pancreas divisum will experience repeated episodes of pancreatitis. This is thought to be due to the high intrapancreatic dorsal ductal pressure caused by the small minor papilla orifice.

References

  1. Morgan DE, Logan K, Baron TH, Koehler RE, Smith JK. Pancreas divisum: implications for diagnostic and therapeutic pancreatography. AJR Am J Roentgenol. 1999 Jul;173(1):193-8. PMID: 10397125

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