Pancreas divisum: is it a surgical disease?
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Pancreas divisum, a congenital anomaly, often causes recurrent acute pancreatitis. Surgical interventions like sphincteroplasty and ductoplasty can offer relief, though some patients may need pancreatic resection.
Area of Science:
- Gastroenterology
- Surgical Procedures
- Pancreatic Diseases
Background:
- Pancreas divisum is a common congenital anomaly of the pancreatic duct system.
- It is frequently associated with recurrent acute pancreatitis, causing significant patient morbidity.
- Diagnosis is typically confirmed via endoscopic retrograde cholangiopancreatography (ERCP).
Observation:
- Six patients with pancreas divisum and recurrent acute pancreatitis underwent surgical treatment.
- The diagnostic hallmark included recurrent abdominal pain, elevated serum amylase, and ERCP confirmation.
- Surgical approaches involved sphincteroplasty of the ampulla of Vater and/or ductoplasty of the accessory papilla.
Findings:
- Five patients received combined sphincteroplasty and ductoplasty; one had sphincteroplasty alone.
- Two patients ultimately required major pancreatic resection for persistent pain.
- Review of 44 surgically treated cases suggests dual sphincteroplasty or dorsal ductoplasty yield favorable outcomes.
Implications:
- Surgical management, particularly dual sphincteroplasty or dorsal ductoplasty, can be effective for pancreas divisum-related pancreatitis.
- Careful patient selection and procedural choice are crucial for successful surgical outcomes.
- Nonoperative management is also an option for select patients identified with this condition.
Abstract:
Six patients with the congenital anomaly, pancreas divisum, and recurrent acute pancreatitis were treated surgically. The diagnostic triad of multiple episodes of abdominal pain with elevated serum amylase and identification of the anomaly by ERCP was present uniformly. Sphincteroplasty of the ampulla of Vater and ductoplasty of the accessory papilla were performed in five patients. One patient had sphincteroplasty only due to failure to identify the accessory duct. Two patients eventually required major pancreatic resection for pain relief. Three additional patients were identified and managed nonoperatively. Data of 44 patients with surgically treated pancreas divisum have been collected from the literature. Review of these patients indicates that dual sphincteroplasty or dorsal ductoplasty are the two most frequently employed procedures and appear to give good results.