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Pancreas divisum in pancreaticobiliary maljunction in children
Keita Terui1, Tomoro Hishiki, Takeshi Saito
1Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chiba, 260-8677, Japan. kta@cc.rim.or.jp
Insights
Pancreas divisum occurs in 1.4% of pediatric pancreaticobiliary maljunction (PBM) cases. This congenital anomaly is rarely associated with PBM and does not always lead to pancreatitis.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Congenital Anomalies
Background:
- Pancreaticobiliary maljunction (PBM) involves an abnormal joining of pancreatic and bile ducts, forming a long common channel.
- PBM and pancreas divisum are congenital anomalies linked to pancreatitis, but their co-occurrence in children is not well-documented.
Purpose of the Study:
- To determine the incidence of pancreas divisum in pediatric patients with PBM.
- To describe the clinical features of pancreas divisum in this specific pediatric population.
Main Methods:
- Evaluated pancreatic duct configurations in 78 pediatric PBM cases using ERCP and/or intraoperative cholangiopancreatography.
- Performed additional minor papilla cannulation when the main pancreatic duct was not fully visualized via the major papilla.
Main Results:
- Successful pancreatography was achieved in 71 out of 78 PBM cases.
- One case (1.4%) presented with complete pancreas divisum, remaining asymptomatic for 10 years postoperatively.
Conclusions:
- Pancreas divisum is found in 1.4% of pediatric PBM cases.
- While a potential cause of pancreatitis in PBM, pancreas divisum is infrequently associated with PBM and does not invariably result in pancreatitis.
Purpose:
Pancreaticobiliary maljunction (PBM) is defined as a congenital anomaly in which the main pancreatic and common bile ducts are joined outside the duodenal wall and forms the long common channel. Although PBM and pancreas divisum are congenital anomalies causing pancreatitides, distinct data about the incidence of pancreas divisum in pediatric PBM has not been reported to date. The present study was designed to reveal the incidence and clinical features of pancreas divisum in cases of PBM.
Methods:
The configurations of pancreatic ducts of 78 pediatric cases of PBM were assessed by endoscopic retrograde cholangiopancreatography (ERCP) and/or intraoperative cholangiopancreatography. Additional cannulation of the minor papilla was performed when the entire length of the main pancreatic duct was not detected with cannulation of the major papilla alone.
Results:
Clear pancreatography was obtained in 71 cases out of 78 cases of PBM. Abnormal fusion of the pancreatic duct was detected in 1 case (1.4%) with complete pancreas divisum. This case was asymptomatic preoperatively and for 10 years postoperatively.
Conclusion:
Pancreas divisum exists in 1.4% of PBM. Although pancreas divisum is one of the pathogenesis of pancreatitis in PBM, is rarely associated with PBM and not always causes pancreatitis.
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