Difficulties in the diagnosis and treatment of pancreas divisum

The anatomic variant pancreas divisum has been implicated as possibly playing a role in the development of idiopathic pancreatitis. A number of recent reports have supported the use of sphincteroplasty of the minor ampulla to treat pancreatitis associated with pancreas divisum. We reviewed the cases of five recent patients with this anomaly who had problems or complications associated with the operative treatment of their pancreatitis. One patient was subsequently found to have adenocarcinoma of the pancreas after pancreatic resection; one patient had restenosis of the minor ampulla; one patient had recurrent pancreatitis following sphincteroplasty; one patient died of pancreatic necrosis postoperatively; and in one patient, no minor ampulla could be identified. Awareness of these complications and the technique of sphincteroplasty are of critical importance to the surgeons caring for these patients.