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Surgical treatment of pancreas divisum causing pancreatitis in children
N S Adzick1, R C Shamberger, H S Winter
1Department of Surgery, The Children's Hospital, Boston, MA 02115.
Insights
Pancreas divisum can cause acute pancreatitis in children if the accessory papilla is narrowed. Surgical intervention, including accessory papilla sphincteroplasty, successfully treated four pediatric cases of recurrent pancreatitis.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Pancreatic Diseases
Background:
- Pancreas divisum is a congenital anomaly where the pancreatic ducts fail to fuse during fetal development.
- It is controversially linked to acute pancreatitis, particularly when accessory papilla drainage is impaired.
Observation:
- Four pediatric patients presented with recurrent acute pancreatitis.
- Diagnosis was confirmed via endoscopic retrograde cholangiopancreatography (ERCP).
- All patients had pancreas divisum with suspected accessory papilla stenosis.
Findings:
- Surgical treatment involving accessory papilla sphincteroplasty, ampullary opening, and cholecystectomy was performed.
- This surgical approach led to successful outcomes in all four children.
- Improved drainage of the Santorini duct was achieved through sphincteroplasty.
Implications:
- Surgical management can be effective for pediatric patients with pancreas divisum and recurrent pancreatitis.
- ERCP is a crucial diagnostic tool for identifying pancreatic duct anomalies.
- Addressing accessory papilla stenosis may prevent future pancreatitis episodes.
Abstract:
Although controversial, pancreas divisum has been implicated as a cause of acute pancreatitis when there is stenosis of the accessory papilla that drains the duct of Santorini. Over the past 5 years, four children with pancreas divisum and recurrent pancreatitis were successfully treated surgically. The diagnosis was made by endoscopic retrograde cholangiopancreatography (ERCP) in each case. Surgical treatment included sphincteroplasty to the accessory papilla to improve drainage of the duct of Santorini, opening the ampulla of Vater to expose the ostium of the duct of Wirsung to enlarge it, and cholecystectomy.