Pancreas divisum and pancreatitis in children

Pancreas divisum, a congenital variant of pancreatic ductal anatomy first described by Opie in 1903, has only recently been thought of as a cause of pancreatitis. The majority of reported patients presenting are middle-aged, with the exact pathogenesis not clearly understood. The reason for this late clinical presentation of a congenital abnormality is also not clear. However, reports of children with recurrent pancreatitis and an associated pancreas divisum have now appeared. None had any identifiable cause of pancreatitis. Pancreas divisum was diagnosed or suspected preoperatively in two, with findings on endoscopic retrograde cholangiopancreatography (ERCP) and gastroduodenoscopy. All findings were confirmed at operation. All underwent surgical treatment with good results within 6 months. Review of the literature showed eight patients younger than 18 years with pancreas divisum and pancreatitis requiring operation. All had good results after surgical repair. It appears that this anomaly can be associated with recurrent pancreatitis in children. Children with recurrent pancreatitis with no obvious cause should be evaluated for pancreas divisum and, if it is found, be surgically treated. The role of ERCP, while not clearly defined, may become critical in the evaluation of pancreas divisum in children.