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Difficulties in the Diagnosis and Treatment of Pancreas Divisum

Difficulties in the Diagnosis and Treatment of Pancreas Divisum Abstract • The anatomic variant pancreas divisum has been implicated as possibly playing a role in the development of idiopathic pancreatitis. A number of recent reports have supported the use of sphincteroplasty of the minor ampulla to treat pancreatitis associated with pancreas divisum. We reviewed the cases of five recent patients with this anomaly who had problems or complications associated with the operative treatment of their pancreatitis. One patient was subsequently found to have adenocarcinoma of the pancreas after pancreatic resection; one patient had restenosis of the minor ampulla; one patient had recurrent pancreatitis following sphincteroplasty; one patient died of pancreatic necrosis postoperatively; and in one patient, no minor ampulla could be identified. Awareness of these complications and the technique of sphincteroplasty are of critical importance to the surgeons caring for these patients. (Arch Surg 1984;119:1088-1091) References 1. Rosch W, Kock H, Shaffner O, et al: The clinical significance of pancreatic divisum . Gastroenterol Endosc 1976;22:206-207.Crossref 2. Mitchell CJ, Lintott DJ, Ruddell WSJ, et al: Clinical relevance of an unfused pancreatic duct system . Gut 1979;20:1066-1071.Crossref 3. Gregg JA: Pancreas divisum: Its association with pancreatitis . Am J Surg 1977;134:539-543.Crossref 4. Heiss F, Shea J: Association of pancreatitis in variant ductal anatomy . Am J Gastroenterol 1979;70:158-162. 5. Tulassay Z, Papp J: New clinical aspects of pancreas divisum . Gastroenterol Endose 1980;26:143-146.Crossref 6. Cotton PB: Congenital anomaly of pancreas divisum as a cause of obstruction pain in pancreatitis . Gut 1980;21:105-114.Crossref 7. Richter JM, Schapiro RH, Mulley RG, et al: Association of pancreas divisum and pancreatitis and its treatment by sphincteroplasty of accessory ampulla . Gastroenterology 1981;81:1104-1110. 8. Cooperman M, Ferrara JJ, Fromkes JJ, et al: Surgical management of pancreas divisum . Am J Surg 1982;143:107-112.Crossref 9. Britt LG, Samuels AD, Johnson JW Jr: Pancreas divisum: Is it a surgical disease? Ann Surg 1983;197:654-662.Crossref 10. Traverso LW, Perry WW, Musser G, et al: Pancreas divisum: The role of pancreatic ductal drainage . Surg Gastroenterol 1982;1:11-16. 11. Warshaw AL, Richter JM, Schapiro RH: The cause and treatment of pancreatitis associated with pancreas divisum . Ann Surg 1983;198:443-452.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Difficulties in the Diagnosis and Treatment of Pancreas Divisum

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Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1984.01390210080017
Publisher site
See Article on Publisher Site

Abstract

Abstract • The anatomic variant pancreas divisum has been implicated as possibly playing a role in the development of idiopathic pancreatitis. A number of recent reports have supported the use of sphincteroplasty of the minor ampulla to treat pancreatitis associated with pancreas divisum. We reviewed the cases of five recent patients with this anomaly who had problems or complications associated with the operative treatment of their pancreatitis. One patient was subsequently found to have adenocarcinoma of the pancreas after pancreatic resection; one patient had restenosis of the minor ampulla; one patient had recurrent pancreatitis following sphincteroplasty; one patient died of pancreatic necrosis postoperatively; and in one patient, no minor ampulla could be identified. Awareness of these complications and the technique of sphincteroplasty are of critical importance to the surgeons caring for these patients. (Arch Surg 1984;119:1088-1091) References 1. Rosch W, Kock H, Shaffner O, et al: The clinical significance of pancreatic divisum . Gastroenterol Endosc 1976;22:206-207.Crossref 2. Mitchell CJ, Lintott DJ, Ruddell WSJ, et al: Clinical relevance of an unfused pancreatic duct system . Gut 1979;20:1066-1071.Crossref 3. Gregg JA: Pancreas divisum: Its association with pancreatitis . Am J Surg 1977;134:539-543.Crossref 4. Heiss F, Shea J: Association of pancreatitis in variant ductal anatomy . Am J Gastroenterol 1979;70:158-162. 5. Tulassay Z, Papp J: New clinical aspects of pancreas divisum . Gastroenterol Endose 1980;26:143-146.Crossref 6. Cotton PB: Congenital anomaly of pancreas divisum as a cause of obstruction pain in pancreatitis . Gut 1980;21:105-114.Crossref 7. Richter JM, Schapiro RH, Mulley RG, et al: Association of pancreas divisum and pancreatitis and its treatment by sphincteroplasty of accessory ampulla . Gastroenterology 1981;81:1104-1110. 8. Cooperman M, Ferrara JJ, Fromkes JJ, et al: Surgical management of pancreas divisum . Am J Surg 1982;143:107-112.Crossref 9. Britt LG, Samuels AD, Johnson JW Jr: Pancreas divisum: Is it a surgical disease? Ann Surg 1983;197:654-662.Crossref 10. Traverso LW, Perry WW, Musser G, et al: Pancreas divisum: The role of pancreatic ductal drainage . Surg Gastroenterol 1982;1:11-16. 11. Warshaw AL, Richter JM, Schapiro RH: The cause and treatment of pancreatitis associated with pancreas divisum . Ann Surg 1983;198:443-452.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1984

References