Embryological etiology of pancreaticobiliary system predicted from pancreaticobiliary maljunction with incomplete pancreatic divisum: a case report

Sanada, Yukihiro; Sakuma, Yoshiki; Sata, Naohiro

doi:10.1186/s12893-018-0385-4

Cited by 4 publications

(1 citation statement)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Prior studies suggested that there is about a 30–38% co-existence between the two conditions[21, 22, 23] but a recent larger study suggested the prevalence is as high as 50%[24]. There have reports scattered in the literature with PD co-existing with anomalous pancreatic-biliary junction (APBJ) and choledochal cysts[25, 26, 27, 28, 29]. However, there have been no large-scale studies to support any specific associations between these congenital anomalies.…”

Section: Associated Pancreatic-biliary Anomaliesmentioning

confidence: 99%

Identification and management of pancreas divisum

Gutta

Fogel

Sherman

2019

Expert Review of Gastroenterology & Hepatology

View full text Add to dashboard Cite

Pancreas divisum, the most common congenital malformation of the pancreas, occurs due to a failure of fusion of the ductal systems of the dorsal and ventral pancreatic buds in the seventh week of intra-uterine life. This leads to a dominant dorsal pancreatic duct draining though the minor papilla and a small ventral pancreatic duct draining through the major papilla. The prevalence in western populations is about 10% and more than 95% of these patients are without pancreatic symptoms, with the anomaly found incidentally on abdominal imaging for an unrelated indication. The etiological role and clinical significance of pancreas divisum in relation to pancreatic disease has not yet been clearly defined, but may predispose to pancreatic disease in co-existence with other factors. Secretin-enhanced Magnetic Resonance Cholangiopancreatography is the non-invasive imaging modality of choice to identify pancreas divisum. Patients may be offered minor papilla therapy when they present with recurrent acute pancreatitis, severe acute pancreatitis and can be considered for therapy in the setting of chronic pancreatitis and chronic abdominal pain of pancreatic origin. Minor papilla endotherapy (sphincterotomy and/or stenting) via Endoscopic Retrograde Cholangiopancreatography and minor papilla surgical therapy have comparable outcomes with endotherapy typically considered first-line due to a favorable adverse event profile. The response to therapy is variable with maximal benefit seen in patients with recurrent acute pancreatitis and least with chronic pancreatic-type abdominal pain. Data supporting either therapy are of low quality as they are predominantly retrospective with a sub-optimal follow up period. Surgical options including a pancreatojejunostomy (Puestow or Frey procedure) or a total pancreatectomy with auto-islet cell transplantation may be considered in a subset of patients.

show abstract