Pancreas divisum is a condition present at birth (congenital), and thought to affect about 10 in 100 people. It is a slightly abnormal formation of the pancreas, which in some people leads to occasional bouts of pancreatic inflammation or pancreatitis. In many people the anomaly is never diagnosed or noticed because it remains asymptomatic and has no symptoms. On its own and especially without symptoms, pancreas divisum may have no effect on life or health, but when pancreatitis occurs with regularity, this can be problematic and require treatment.
In pancreas divisum, the way the pancreas drains is different due to abnormal development. In utero, fetuses have two drainage tubes, called the ventral and dorsal ducts, which merge together to form a single tube called the pancreatic duct. Sometimes fusion of these tubes doesn’t occur and the pancreas drainage is thus divided into two (divisum). It should be stressed that this scenario is not always problematic and may never require treatment.
Doctors might suspect pancreas divisum if people have recurrent episodes of pancreatitis. Symptoms of pancreatitis include severe pain in the upper abdomen, possibly fever, nausea or vomiting, a sensation of being extremely unwell, and potentially swelling of the abdomen. Conditions like jaundice or skin rash may also be present. One episode of pancreatitis might not be enough rationale for testing for pancreas divisum, but several bouts of pancreatitis could suggest a congenitally abnormal pancreas.
There are several ways to diagnose this condition. Doctors can perform an endoscopy but this is often thought risky because it may cause pancreatitis, and most doctors don’t want to risk another patient flare up of this inflammatory illness because it is so uncomfortable. Other ways to evaluate shape and structure of the pancreas are to use ultrasound or magnetic resonance imaging (MRI).
If pancreas divisum is diagnosed, the next decision is what to about it. There are not that many treatments for it except to consider reconstructive surgery of the pancreas that would essentially create a single drainage duct or to enlarge one of the ducts for better drainage, usually with stent placement. These surgeries are delicate and are best left to doctors with significant experience in this area. It’s advised people find experts who have handled many cases of this condition surgically.
After surgery many people recover well and do have a decreased incidence of pancreatitis, or they may suffer no cases of it at all. Some people don’t opt for surgery but if they develop pancreatitis frequently they are not only uncomfortable but may place themselves at risk for life-threatening complications. The pancreas may become damaged in these frequent inflammatory attacks, or other organs may be impaired. Generally, if pancreatitis occurs often, surgery is the best method for addressing pancreas divisum.
