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Pancreas Divisum in Children and Duodenum-Preserving Resection of the Pancreatic Head
Jiri Snajdauf1,2, Ondrej Petru2, Jiri Nahlovsky2
1Department of Paediatric Surgery, Institute of Postgraduate Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
Insights
Pancreas divisum (PD) in children often presents with recurrent epigastric pain. Endoscopic retrograde cholangiopancreatography (ERCP) papillotomy is a primary treatment, with surgery reserved for severe cases.
Area of Science:
- Pediatric Gastroenterology
- Surgical Gastroenterology
Background:
- Pancreas divisum (PD) is a congenital anomaly of the pancreatic duct system.
- Symptomatic PD in children can lead to recurrent pancreatitis and abdominal pain.
Purpose of the Study:
- To evaluate clinical features, diagnostic methods, and treatment outcomes for pediatric patients with symptomatic pancreas divisum.
Main Methods:
- Retrospective analysis of seven pediatric patients treated for symptomatic PD between 1999 and 2014.
- Evaluation included clinical presentation, diagnostic imaging (ERCP), and treatment modalities (ERCP papillotomy, surgery).
Main Results:
- Seven children with symptomatic PD were followed for a median of 8 years.
- Recurrent epigastric pain was the primary symptom; pancreatitis confirmed by elevated enzymes.
- ERCP diagnosis confirmed PD in all cases. Three patients improved after ERCP papillotomy; one required duodenum-preserving pancreatic head resection (DPRPH) with good outcome.
Conclusions:
- ERCP papillotomy is the initial treatment of choice for symptomatic PD in children.
- Surgical intervention, such as DPRPH, is a safe and feasible option for refractory cases of severe pancreatitis.
Introduction:
A retrospective study was performed to evaluate the clinical features, diagnostic methods, and treatment alternatives in children with pancreas divisum (PD).
Materials And Methods:
Patients who underwent treatment for PD between 1999 and 2014 at our department were evaluated for sex, age, presenting symptoms, physical examination findings, biochemical markers, diagnostic methods, treatment modalities, and results of treatment during follow-up.
Results:
Seven patients who underwent treatment of symptomatic PD were included in the study. The median for follow-up period was 8 years (from 26 months to 16 years). Male-to-female ratio was 4:3 and the median age at presentation was 11 years (2-14 years). Presenting symptoms were recurrent episodic epigastric pain. Pancreatitis was documented by elevated amylase or lipase levels. Endoscopic retrograde cholangiopancreatography (ERCP) was the method of diagnosis of PD in all patients. Five patients had complete PD and two had incomplete variants. Three patients improved after ERCP papillotomy. In three patients, papillotomy was unsuccessful but they have only mild episodes of pancreatitis. One patient presented at the age of 4 years with recurrent pancreatitis. She was treated surgically by duodenum-preserving resection of the pancreatic head (DPRPH) because of severe recurrent pancreatitis occurring even after ERCP papillotomy. The patient is 26 months after operation without any reported problems.
Conclusion:
Patients with symptomatic PD are indicated for ERCP papillotomy attempt. If there is not improvement after ERCP, then recurrent bouts of severe pancreatitis are considered as an indication for surgical procedure. DPRPH is a safe and feasible surgical alternative.