What is Pancreas Divisum & How is it Treated?

What is Pancreas Divisum?

Pancreas is a vital organ of the body. It is located behind the stomach and functions by aiding in digestion by secreting enzymes. The enzymes secreted by the pancreas enter the intestine through narrow structure called the ducts. During conception and development of the embryo, the pancreas has two ducts, ventral and dorsal. These two ducts over time as the pregnancy progresses fuse together and form one main duct which is termed as the pancreatic duct. However, in some cases, these two ducts fail to fuse together giving rise to a condition called Pancreas Divisum.[1,2]

During the development stage of the embryo the enzymes secreted by the pancreas is drained through the dorsal duct into the major papilla. Only a small quantity is secreted through the ventral duct into the minor papilla. In a person with Pancreas Divisum the reverse of this happens as the two pancreatic ducts fail to fuse and the majority of the secretions are drained through the ventral duct into the major papilla and the enzymes from the dorsal duct drains into the minor papilla.[1,2]

Pancreas Divisum population wise affects about 10% of people. In majority of the cases, Pancreas Divisum does not have any symptoms and the diagnosis is made incidentally while monitoring for some other medical condition.[1,2]

What are the Symptoms of Pancreas Divisum?

As stated, in most cases Pancreas Divisum is asymptomatic. However, there may be abdominal bloating, pain in the abdomen, and jaundice noted. Some people also complain of frequent bouts of nausea and vomiting along with intolerance of food. Some people may also have recurrent inflammation of the pancreas, a condition called as pancreatitis as a result of Pancreas Divisum.[1,2]

How Is Pancreas Divisum Diagnosed?

Pancreas Divisum can be easily diagnosed through MRCP or ERCP. The scans explore the inner structures around the pancreas and the two separate pancreatic ducts can be easily seen through these scans. MRCP utilizes radio waves and magnetic field to generate precision images around the pancreas. It is a completely noninvasive process. It is normally done with contrast for better delineation of images and accurate diagnosis.[2]

On the other hand, an ERCP is minimally invasive in which a camera is inserted from the mouth to the small intestine through the stomach. This also gives pretty accurate pictures of the pancreas and gives a clear diagnosis of Pancreas Divisum. It should be noted here that since mostly Pancreas Divisum is asymptomatic it is quite normal for the condition to be detected while the procedures are done for some other condition.[2]

How is Pancreas Divisum Treated?

Pancreas Divisum does not require any treatment as rarely it causes any symptoms and has no bearing on the overall health or life of the patient. However, in people with frequent bouts of pancreatitis due to Pancreas Divisum a procedure may be required to increase the size of the minor papilla to decrease the inflammation. This can be done by a sphincterotomy.[2]

There are two types of sphincterotomy, medical and surgical. A medical sphincterotomy is done by inserting an endoscope and cutting open the minor duct after positive identification. In surgical sphincterotomy, a laser beam is sued to cut open the minor duct that is large open to allow easy drainage of the digestive enzyme through the duct.[2]

Pancreas Divisum can also be managed at home. According to the National Pancreas Foundation, following a low fat diet is essential for people with Pancreas Divisum. Abstinence from alcohol is a must for all people with a pancreatic disorder including Pancreas Divisum. In case of a flare-up of pancreatitis due to Pancreas Divisum, limiting food intake is very effective.[2]

In summary, Pancreas Divisum is a condition that occurs during fetal development. It occurs when the two ducts of the pancreas fail to fuse into one. Since this abnormality occurs before the birth of a child, it cannot be prevented. However, Pancreas Divisum does affect the overall health of a person and has no effect on the quality of life.[1,2]

People with Pancreas Divisum may be prone to frequent episodes of pancreatitis but this is something which can be controlled with medications and lifestyle modification. In people who experience symptoms it is essential to contact with a physician to go through the treatment options available for Pancreas Divisum.[1,2]

References: