[Pancreas divisum].

Abstract

Pancreas divisum represents a developmental failure of the ducts of the dorsal and ventral pancreas to fuse during the second month of gestation. It results in separate drainage of the ventrally situated head of the pancreas through the main ampulla of Vater, via the duct of Wirsung, and drainage of the body and tail by the duct of Santorini through the much smaller accessory ampulla. It is a surprisingly frequent congenital abnormali ty present in 4.7-14% of necropsy series and has been demonstrated in 0.3-5.8% of patients undergoing endoscopic retrograde pancreatography (1). The etiologic relationship of pancreas divisum to pancreatitis is unresolved. Cotton and Kizu (2), in 1977, first described an increased incidence of pancreatitis in patients with pancreas divisum. While some investigators have supported pancreas divisum as a cause of acute recurrent pancreatitis (3-5), others have not been able to document such an association (6-8), and there is little evidence to support it as a cause of chronic pancreatitis (9). However , we have recently encountered a patient in whom the clinical course and radiologic and histopathologic findings supported an etiologic relationship between pancreas divisum and chronic pancreatitis.