Clinical importance of pancreas divisum

Pancreas divisum, the most common congenital pancreatic anomaly, is associated with three main duct abnormalities: type I, with total failure of fusion; type II, with dorsal duct dominant drainage; and type III, incomplete divisum where a small communication branch is present. Three clinical conditions are associated with pancreas divisum: (1) acute recurrent pancreatitis; (2) chronic pancreatitis with the chronic inflammation in the dorsal bed; (3) abdominal "pancreatic-type" obstructive pain. Endoscopic retrograde cholangiopancreatography is the primary method for diagnosing pancreas divisum, but magnetic resonance cholangiopancreatography is becoming a first choice for non-invasive evaluation. Pancreas divisum per se does not require medical intervention. Patients who experience mild episodic acute pancreatitis should be managed medically. Surgical or endoscopic interventions relieve the obstruction by improving dorsal duct drainage via the minor papilla.