PANCREAS DIVISUM AND ACUTE PANCREATITIS: ROMANCING THE STONE?

From a center with a major interest in pancreatitis come another report implicating pancreas divisum as an anatomic variant with pathologic significance. They reviewed 1,825 endoscopic retrograde cholangiopancreatograph (ERCP) studies performed over a 7‐yr span. The patients were classified into seven groups depending upon the clinical findings, and the incidence of pancreas divisum was determined. The overall incidence of division was 7.5%, and the most significant correlation was a 50% incidence of divisum in patients with acute idiopathic pancreatitis. Other statistically significant associations were biliary pancreatitis (23.7%) and gallbladder stones (16.0%). The control patients were those with a normal ERCP, in whom no organic or functional disease could be discerned. Most had been referred for potential pancreatic pathology. No association was found in patients with chronic pancreatilis, pancreatic or biliary neoplasia, papillary muscle dysfunction, or choledocholithiasis. In the discussion, they cover the divisum controversy well, documenting the wide divergence of opinion on the incidence of the abnormality itself, and mentioning that other centers had found a lack of any association with pancreatitis. Also, they mention that they found a low but significant association with liver disease, compared with their normal controls, but the significance was absent when compared with the “general population,” and the situation was not discussed further. They offer no explanation for the association of divisum with cholelithiasis or biliary pancreatitis.