Diagnostic significance of pancreas divisum in early life

Pancreas divisum (PD) is a congenital anomaly in which the ventral and dorsal pancreatic ducts fails to fuse in the early fetal period. This anomaly has been known to rarely cause recurrent pancreatitis and to require surgical intervention. With the recent advances in image diagnostic procedures, an increasing incidence of this anomaly has been recognized in the pediatric age group. Seven cases of PD were encountered in our institution between 1978 and 1998. Six were female and one was male, with a mean age of 8 years. All cases were diagnosed to have PD by endoscopic retrograde pancreatography (ERCP) or operative pancreatography. One case (14.3%) had PD associated with a bout of pancreatitis and was operated on by transduodenal papilloplasty, but recurrent bouts of pancreatitis led to the performance of longitudinal pancreaticojejunostomy (Puestow procedure). Six cases (85.7%) were found to have PD as an incidental finding during operation for congenital dilatation of the bile ducts (CDBD), however, 2 cases (33.3%) out of the 6 developed pancreatitis in a later stage and ERCP was effective in their follow-up assessment. One benefited from conservative treatment while the other needed transduodenal papilloplasty along with pancreatoductoplasty. Imaging procedures (ERCP or operative pancreatography) revealed complete PD in 3 cases (42.9%), and incomplete PD in 4 cases (57.1%), however, there was no clinically significant difference between the groups.