Pancreas divisum: incidence, detection, and clinical significance

Pancreas divisum is a congenital anomaly in which the ventral and dorsal pancreas drain separately into the duodenum. It is the most common congenital variant of pancreatic duetal fusion and drainage anomalies. With widespread use of endoscopic retrograde cholangiopancreatography, pancreas divisum is being detected with increasing frequency. Jen eases of pancreas divisum delected among 500 endoseopie retrograde cholangiopancreatography examinations performed between 1979 and 1985 at our institution were critically analyzed. Patients with symptomatic pancreas divisum (group 1) were typically young (mean age 29 yr), usually female, and had no history of significant alcohol abuse. Those with incidental detection of pancreas divisum (group 2) were older (mean age 62 yr), usually male with hepatohiliary disease, and had a history of signifieant alcohol ingestion. I he radiological feature of pancreas divisum is characterized by a short (1-6 em) and thin (2 mm diameter) pancreatic duet (duct of VVirsung) that hranches off into regular arborization and drains only the posterior part ofthe head ofthe panereas. Ihis appearance is quite typical; however, this may be simulated by otber conditions such as previous pancreatic trauma, partial pancreatectomy, or pancreatitis with irreiersihie damage to tbe duet, pseudocyst, and panereatic carcinoma. I be differentiation between true and false panereas divisum is important because of its clinical implieations.