Pancreas Divisum Research Articles

Novel method for retrieving Santorini duct stones from a patient with a rare chymotrypsin C variant combined with pancreas divisum.

Novel method for retrieving Santorini duct stones from a patient with a rare chymotrypsin C variant combined with pancreas divisum.

Pancreatic Divisum in Children

Pancreatic Divisum in Children

70 Cases of Incomplete Pancreatic Divisum (IPD)-The Usefulness of MRCP Diagnosis and the Safety of Endoscopic Treatments via Duodenal Major and Minor Papilla

70 Cases of Incomplete Pancreatic Divisum (IPD)-The Usefulness of MRCP Diagnosis and the Safety of Endoscopic Treatments via Duodenal Major and Minor Papilla

Left Sided Gall Bladder with Choledochal Cyst and Pancreatic Divisum

Left Sided Gall Bladder with Choledochal Cyst and Pancreatic Divisum

A Case of Mirizzi Syndrome with Pancreatic Divisum

A Case of Mirizzi Syndrome with Pancreatic Divisum

Groove pancreatitis: From enigma to future directions-A comprehensive review.

Groove pancreatitis (GP) is a rare and clinically distinct form of chronic pancreatitis affecting the pancreaticoduodenal groove comprising the head of the pancreas, duodenum, and the common bile duct. It is more prevalent in individuals in their 4-5th decade of life and disproportionately affects men compared with women. Excessive alcohol consumption, tobacco smoking, pancreatic ductal stones, pancreatic divisum, annular pancreas, ectopic pancreas, duodenal wall thickening, and peptic ulcers are significant risk factors implicated in the development of GP. The usual presenting symptoms include severe abdominal pain, nausea, vomiting, diarrhea, weight loss, and jaundice. Establishing a diagnosis of GP is often challenging due to significant clinical and radiological overlap with numerous benign and malignant conditions affecting the same anatomical location. This can lead to a delay in initiation of treatment leading to increasing morbidity, mortality, and complication rates. Promising research in artificial intelligence (AI) has garnered immense interest in recent years. Due to its widespread application in diagnostic imaging with a high degree of sensitivity and specificity, AI has the potential of becoming a vital tool in differentiating GP from pancreatic malignancies, thereby preventing a missed or delayed diagnosis. In this article, we provide a comprehensive review of GP, covering the etiology, pathogenesis, clinical presentation, radiological and endoscopic evaluation, management strategies, and future directions. This article also aims to increase awareness about this lesser known and often-misdiagnosed clinical entity amongst clinicians to ultimately improve patient outcomes.

Endoscopic pancreatic interventions in children

Aim. To increase the efficiency of surgical treatment for children with pancreatic malformations and diseases using endoscopic interventions. Materials and methods. The study enrolled 39 children aged 3–17 years who underwent 58 endoscopic interventions. Results. Transpapillary interventions were performed in 14 children with pancreatic duct abnormalities. Stenosis of the proximal pancreatic ducts was revealed in 5 observations – stenting was performed. Lithiasis of Wirsung's duct was confirmed in 4 observations, an abnormality in the form of an incomplete pancreas divisum was revealed in 3 of them. Pancreas divisum was detected in 1 patient, sphincterotomy of the minor duodenal papilla was performed. Transmural interventions were carried out in 24 observations: puncture – in 10 patients with intra- or parapancreatic cystic formations, drainage – in 14 patients with pseudocysts. Combined transpapillary and transmural surgery was performed in a child with traumatic pancreatic disruption. Conclusion. Transpapillary interventions prove to effectively eliminate hypertension in the pancreatic ducts in children. Transmural procedures can be used to drain pancreatic pseudocysts in children.

The crossing duct sign of pancreas divisum

Pancreas divisum is the most common congenital malformation of the pancreatic ductal system, it has been reported to affect approximately 4-14% of the general population [1].

Choledochal Cyst with Pancreas Divisum – Surgical Insight into A Rare Association


 
 
 
 Congenital pancreaticobiliary anomalies like pancreatic divisum (PD), choledochal cysts (CDC), anomalous pancreaticobiliary ductal union (APBDU) have been reported in 5.7% of patients undergoing magnetic resonance cholangiopancreatography. CDC’s are characterized by abnormal dilatations of the intrahepatic and/or extrahepatic portion of the biliary tree and can be complicated by cystolithiasis, cholangitis, pancreatitis and malignant transformation necessitating surgical managemnet. While CDCs are commonly associated with APBDU, combination of CDC with PD is rare and a potential surgical challenge. We report a case of recurrent cholangitis in a patient with CDC and coincidental classic PD and illustrate how preoperative identification, fastidious dissection technique to safeguard both the pancreatic ducts and simple intraoperative preemptive strategies may decrease consequences of distal stump blowout. PD, pancreatic divisum; CBD, common bile duct; CDC, choledochal cysts; APBDU, anomalous pancreaticobiliary ductal union; MRCP, magnetic resonance cholangiopancreatography; DOS, Duct of Santorini; DOW, Duct of Wirsung; PTBD, percutaneous transhepatic biliary drainage; RYHJ, roux en Y hepaticojejunostomy.
 
 
 

Advances in minimally invasive endoscopic treatment of pancreatic divisum

Advances in minimally invasive endoscopic treatment of pancreatic divisum

Exploring the Burden and Outcome of Acute Pancreatitis: An Experience from a Tertiary Referral Center

Background and Aims: Changing trends are observed in acute pancreatitis (AP); hence, this study was conducted to determine various etiologies, severity, complications, and outcome of AP. Materials and Methods: A retrospective study was conducted on admitted 122 AP patients. Results: The male:female ratio was 1.77. The mean age was 34.11 ± 15.45 years. Various etiologies were alcohol seen in 26.2%, gallstones in 22.1%, postendoscopic retrograde cholangiopancreatography (ERCP) in 15.6%, pancreatic divisum in 4.9%, hypercalcemia in 0.8%, hypertriglyceridemia in 0.8%, viral in 0.8%, worm in 0.8%, and idiopathic in 32.8% of patients. Mild, moderately severe, and severe AP were seen in 46.7%, 36.1%, and 17.2% cases, respectively. Among local complications, peripancreatic collections were seen in 25.4%, pseudocyst or walled-off necrosis in 23.8%, ascites in 26.2%, pleural effusion in 23%, biliary obstruction in 4.9%, vascular thrombosis in 3.3%, intestinal obstruction in 3.3%, upper gastrointestinal bleed in 2.5%, and gastric outlet obstruction in 1.6% of patients. Total 27 patients had organ failure, out of which 6 had transient. Respiratory failure was the most common, followed by renal failure and circulatory failure. Percutaneous drainage was performed in 11 and endoscopic ultrasound-guided drainage in 3 patients. Mortality rate was 6.6%. Conclusions: Common etiologies of AP were idiopathic, alcohol, biliary, and post-ERCP. Mortality was 6.6% attributed to respiratory failure in severe AP.

Efficacy of Endoscopic Therapy in Symptomatic Pancreatic Divisum: A Systematic Review and Meta-analysis.

Pancreas divisum (PD) is a congenital malformation of the pancreas and is implicated as a cause of pancreatitis. The role of endotherapy has been variable in symptomatic PD indicated by recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), or chronic pancreatic-type abdominal pain (PP). The aim of this study was to analyze the pooled data to determine the success of endoscopic intervention for pancreas divisum. We conducted a comprehensive search of several databases (inception to July 2023) to identify studies reporting on the use of endoscopic therapy in symptomatic pancreatic divisum. The random-effects model was used to calculate the pooled rates and I2% values were used to assess the heterogeneity. A total of 27 studies were retrieved that reported endoscopic intervention in pancreatic divisum. The calculated pooled rate of technical success was 92% (95% CI: 87-95; I2=63%). The calculated pooled rate of clinical success was 65% (95% CI: 60-70; I2=60%). The rate of clinical success by PD subtypes was highest in RAP at 71% (95% CI: 65-76; I2=24%). Available studies had significant heterogeneity in defining clinical success. The rate of adverse events was 71% (95% CI: 65-76; I2=24%). The role of endoscopic therapy in pancreatic divisum is variable with the highest success rate in recurrent acute pancreatitis. Endoscopic intervention is associated with a higher-than-usual rate of adverse events, including post-ERCP pancreatitis.

Safety and efficacy of endoscopic retrograde cholangiopancreatography in pediatric pancreatic and biliary disorders.

There is sparse data from India on indications, technical success, safety and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) using standard adult duodenoscope in the pediatric population. Retrospective analysis of prospectively maintained electronic endoscopy and clinical database was performed to identify pediatric patients (age ≤ 18years) who underwent ERCP between January 2017 and December 2022. Demographics and procedural details including indications, cholangio-pancreatogram findings, endotherapy type performed, technical and clinical success and complications were noted. As many as 150 pediatric patients were included of whom 88 had pancreatic (mean age-13.7years) and 62 had biliary disease (mean age- 14.9years). Common pancreatic ERCP indications were chronic pancreatitis (n = 45 [51.1%]), pancreatic duct disruption fistula (n = 21 [23.9%]) and recurrent acute pancreatitis (n = 16 [18.2%]). Among biliary indications were choledocholithiasis (n = 29 [46.8%]), benign bile duct strictures (n = 13 [21%]), bile duct injury/leak and biliary stent removal (n = 7 [11.3%]) , choledochal cyst (n = 5 [8.1%]) and pancreatic mass causing biliary compression (n = 1 [1.6%]). Technical success in pancreatic and biliary ERCP was 94.3% and 95.2%, respectively, and clinical success was 84.1% and 93.5%, respectively. Most common complications following pancreatic ERCPs were acute pancreatitis (n = 9 [10.2%]) (mild = 5, moderate = 4) patients and post sphincterotomy bleed in one (1.1%). Among biliary ERCPs, post ERCP pancreatitis was seen in (n = 3 [4.8%]) (mild = 2, moderate = 1). ERCP can be safely and effectively performed in children using standard duodenoscope. Chronic pancreatitis, choledocholithiasis and pancreatic divisum are common pediatric ERCP indications.

Endoscopic Ultrasound-Guided Rendezvous Pancreatic Duct Stenting in Pancreas Divisum Using Modified Cannula

AbstractThis video is of a 65 year old female patient with history of systemic hypertension, type 2 diabetes and coronary artery disease on medical management. She presented with features of acute pancreatitis which was managed conservatively and imaging showed features of chronic pancreatitis with dilated pancreatic duct and pancreas divisum was suggested. She had two further episodes of acute pancreatitis and was managed conservatively. Pancreatic stenting was suggested but during ERCP minor papillae couldn't be identified. Hence, EUS guided Rendez - vous pancreatic duct puncture and minor papillae stenting was done with the help of a modified cannula.

P343 Pancreato-biliary disorders in patients with inflammatory bowel diseases – a single-centre report

Abstract Background Inflammatory bowel diseases (IBD) are regarded as multisystemic disorders due to the high prevalence of extraintestinal symptoms. Hepato-pancreato-biliary involvement can be present in up to 50% of patients, due to IBD extraintestinal manifestations and complications. Our aim was to evaluate the prevalence of the pancreato-biliary diseases in patients diagnosed with IBD. Methods We conducted a single-centre retrospective study which included patients diagnosed with Crohn’s disease (CD) and ulcerative colitis (UC), admitted between 1 January 2018 and 1 August 2023 in the Gastroenterology and Surgery Departments of the Fundeni Clinical Institute (Romania). We analysed the medical history (including abdominal imaging - ultrasound, computed tomography or magnetic resonance imaging) of patients during hospital follow-up and we screened for pancreato-biliary disorders. Results We analysed 1736 patients, of which 303 patients (17%) associated pancreato-biliary involvement and 756 patients (44%) had no pancreato-biliary disorders, with both subgroups having at least one abdominal imaging scan during follow-up; 677 patients (39%) had neither history of pancreato-biliary disorders, nor abdominal imaging. 30 patients (1.72% of total; 56.6% CD, 77% male) had acute pancreatitis (93.3% mild), 66.67% being drug-induced (13 cases - azathioprine, six cases - 5-amynosalicilates, one case - metronidazole). Three patients were diagnosed with idiopathic chronic pancreatitis and one with type 2 autoimmune pancreatitis. In the subgroup that underwent abdominal imaging (1059 patients) we identified 124 patients (11.70%) with pancreatic steatosis, 11 patients (1.03%) with pancreatic cysts (one case of intraductal papillary mucinous neoplasm) and three patients (0.28%) with congenital pancreatic anomalies (two annular pancreases, one pancreas divisum). There were no patients diagnosed with pancreatic adenocarcinoma. We identified 14 patients (0.8% from total; 64.28% UC, 57.14% male) with primary sclerosing cholangitis, of which five underwent liver transplantation, one case of primary biliary cholangitis and three cases of cholangiocarcinoma. The subgroup with abdominal imaging included 46 patients (4.34%) with prior cholecystectomy and 147 patients (13.88%) with gallbladder lithiasis or sludge (59.86% CD; 53.06% male; 39.45% intestinal resection). Conclusion Up to one third of patients with IBD that underwent abdominal imaging associated pancreato-biliary involvement. The high risk of drug-induced acute pancreatitis in IBD has to be taken into consideration. Screening for possible extraintestinal manifestations and early diagnosis of extraintestinal complications might improve the IBD management.

Stenting the minor papilla to control a leak after a left pancreatectomy with pancreatic divisum

Stenting the minor papilla to control a leak after a left pancreatectomy with pancreatic divisum

Anatomical Variations of Pancreas Divisum in Magnetic Resonance Cholangiopancreatography: A Cross-sectional Study

Introduction: Pancreas divisum is the most common congenital anomaly of the pancreas. It occurs due to failure of fusion of the dorsal and ventral pancreatic buds in the 7th week of intrauterine life, and leads to the formation of a large dorsal pancreatic duct and a small ventral pancreatic duct. Different types of pancreas divisum had been reported in the literature due to varying patterns of fusion of the dorsal and ventral pancreatic ducts. Aim: The present study had been performed to find out the anatomical variations of pancreas divisum, pancreatic ducts and associated congenital anomalies. Materials and Methods: The present cross-sectional retrospective study was carried out in the Department of Radiology, Gauhati Medical College and Hospital, Guwahati, Assam from January 2022 to March 2023. The Magnetic Resonance Cholangiopancreatography (MRCP) plates of 159 patients were collected and studied for variations of pancreas divisum, pancreatic ducts and associated congenital anomalies. Results: In the present study, 34 (29.8%) cases had Type-1 (classical), 5 (4.4%) cases had Type-2 and 75 (65.9%) cases had Type-3 pancreas divisum. Also, 105 (66.03%) cases had Type-1 pancreatic duct and 34 (21.4%) cases had Type-4 pancreatic duct. Four (21%) cases had associated Komi Type- 2A, a choledochal cyst. Conclusion: In the present study, Type-3 pancreas divisum was most common. Also, most cases had Type-1 Major Pancreatic Duct (MPD). Choledochal cysts were found to be mostly associated with pancreas divisum.

Whipple procedure as a surgical treatment for pancreas divisum: case report

Whipple procedure as a surgical treatment for pancreas divisum: case report

Modified double-wire technique for deep cannulation of dorsal duct in incomplete pancreas divisum

Modified double-wire technique for deep cannulation of dorsal duct in incomplete pancreas divisum

Transpapillary Drainage of Pancreatic Pseudocyst via Minor Ampulla in a Patient with Acquired Pancreas Divisum: Case Report

Transpapillary Drainage of Pancreatic Pseudocyst via Minor Ampulla in a Patient with Acquired Pancreas Divisum: Case Report