Clinical course and morphological features of chronic calcifying pancreatitis associated with pancreas divisum

To describe the clinical and radiological patterns of chronic calcifying pancreatitis (CCP) associated with pancreas divisum.

Case-control study.

Pancreas divisum was diagnosed in 20 out of 411 patients presenting with CCP between 1985 and 1994 (group I). They were matched for age and sex with 20 patients presenting with CCP but without pancreas divisum (group II). The cause of CCP was presumed to be mainly chronic alcohol use, as 18 patients in each group had heavy alcohol consumption.

The age at onset of the disease was comparable in the two groups (mean 40.8 compared with 42.4 years, NS), and consumption of alcohol and tobacco did not differ. Pancreatic calcified calculi were seen on plain films of the abdomen in eight patients from group I and in 14 patients from group II (P = 0.05). Loss of weight (> 5 kg), diabetes, portal hypertension and the rate of complications of chronic pancreatitis were not significantly different in the two groups. The frequency of attacks of acute pancreatitis was similar (mean 0.9 compared with 1.2 per year, range 0.2-6.0 per year, NS). The occurrence of pseudocysts did not differ (11 compared with 15, NS). Pancreatograms were categorized using the Cambridge classification. No differences could be demonstrated between the two groups (chi 2, P = 0.15). In group I, pancreatographic abnormalities were located only in the ventral segment of the pancreas in three patients, only in the dorsal segment of the pancreas in nine patients and in the whole pancreas in six patients. In two patients, the ventral duct could not be demonstrated.

We conclude that pancreas divisum does not modify the natural course of CCP. In about one-half of cases, pancreatographic abnormalities may be segmental.