Incomplete Pancreas Divisum: Is It Merely a Normal Anatomic Variant without Clinical Implications?

Abstract

The prevalence rate, symptom occurrence rate, clinical presentation, and outcomes of endoscopic treatment were similar in patients with complete PD and incomplete PD. Incomplete PD may therefore have similar clinical implications to those of complete PD.

Dynamic Secretin-enhanced MR Cholangiopancreatography

“…Minor papilla sphincterotomy is the usual treatment for recurrent pancreatitis or disabling abdominal pain in patients with a divided pancreas. Traditionally, incomplete pancreas divisum was thought less likely than complete divisum to be associated with pancreatitis, since high pressure in the dorsal pancreatic duct system could be decreased via a connection to the ventral duct (Fig 4); however, this notion has been challenged by some investigators (5). The sensitivity of MR cholangiopancreatography for detection of pancreas divisum is considerably increased with the use of secretin (3,6,7) (Fig 5).…”

Pancreaticobiliary malunion and incomplete pancreas divisum: an unusual cause of common bile duct obstruction

“…A comparison of cases with complete and incomplete pancreas divisum [12] indicated that the symptoms, clinical presentation and outcome of endoscopic treatment were similar in both groups. However, with regard to the dorsal pancreatic duct predominance described in the case report, we assume that the coexistence of incomplete pancreas divisum and PBM may reduce biliary cancer risk compared with patients with PBM alone.…”

“…This hypothesis is indirectly supported by cessation of recurrent pancreatitis attacks after endoscopic treatment in some patients. In incomplete pancreas divisum, considered merely an anatomic variant of pancreas divisum [12], a segmental branch connects the ventral and dorsal pancreas.…”

Imaging of the Pancreas With Secretin Enhancement

“…Traditionally, an incomplete divisum was thought to be less likely to be associated with pancreatitis because high pressure in the dorsal ductal system may be deflated via the connection to the ventral duct, although this notion has been challenged by a recent publication. 8 The accuracy of diagnosing a pancreas divisum with MRCP is considerably increased with use of secretin. 6,9,10 Magnetic resonance cholangiopancreatography can also detect the presence of a santorinicele, which is a focal distention of the distal dorsal (Santorini) duct probably as a result of impaired flow though the minor papilla.…”