[Recurrent acute pancreatitis, associated with pancreas divisum. Clinical study of 12 cases]

Sixty-three cases of pancreas divisum were diagnosed in a series of 2,800 endoscopic retrograde cholangiopancreatographies performed between 1976 and 1982. This anomaly was significantly associated with recurrent pancreatitis. Based on 12 cases in which the only possible causative factor of acute pancreatitis was pancreas divisum, the symptoms of this association are described. There were seven males and five females. Average age at the onset of symptoms was 35.3 +/- 12.4 years. Heavy to moderate consumption of alcohol was never found; protein and fat intakes were within normal ranges. All patients presented with acute recurrent pancreatitis, half of them having suffered three to five attacks. The duration of troubles ranged from 6 months to 14 years. In half of the cases the attacks did not last more than twelve hours and were of moderate intensity. Even in case of frequent attacks, no loss of weight was observed. These features are different from that of chronic calcifying pancreatitis. Ultrasonography showed the intrapancreatic course of the mesenteric vein and/or the appearance of two areas of different tonality in the pancreatic head in 58 p. 100 of cases. Endoscopic retrograde cholangiopancreatography was always able to make the diagnosis of pancreas divisum. After 7 endoscopic and 2 surgical sections of the minor papilla symptoms regressed completely in 4 cases and improved in 3 cases (follow-up 2 to 36 months).