PANCREAS DIVISUM—ANOTHER DIAGNOSTIC TEST?

Pancreas divisum is the most common variant of pancreatic anatomy, appearing in the 8th wk of fetal development as a failure of fusion of the duct of Santorini and duct of Wirsung. This failure of ductular union is a controversial etiology in the pathogenesis of pancreatitis, with relative stenosis at the minor papilla being the proposed cause. The authors performed dynamic nonenhanced computerized tomograpbic (CT) scans with 5‐mm cuts through the pancreas to localize the main pancreatic duct (PD) in 29 patients with upper abdominal pain who bad had successful endoscopic retrograde pancreatograpby (ERP) via both the major and minor ampulla. The demonstrated anatomy was either complete (21 cases) or incomplete divisum (eight cases), and they were considered together. Once the PD was located, 70 IDU of Kabi secretin was administered intravenously, and the PD was scanned with 3‐mm cuts at 0,10, 20, and 50 min. Serum amylase determinations were done at the same intervals. By ERP criteria, using the Cambridge symposium classification, 6/29 had severe pancreatitis, 6/29 had moderate pancreatitis, and 17/29 had no signs of pancreatitis. On CT, the dorsal PD was localized in 6/6 patients with severe pancreatitis with no significant change with secretin, whereas 4/6 and 6/17 had visualization in the moderate and “nopancreatitis” groups, respectively. With secretin, there was an increase in PD diameter which was greatest at 10 min, and was proportionally greater in the no‐pancreatitis group (21 vs. 18%). The overall success rate of duct visualization by CT scanning was 21/29 with secretin, with the six additional pickups coming from the no‐pancreatitis group. Normal controls consisted of 11 patients with normal PD anatomy, and only 2/11 were visualized prior to and after secretin. The final conclusion was that the finding of PD ductular dilation with secretin stimulation demonstrated by CT scan is suggestive of pancreas divisum.