History and Physical Examination

History

Pancreas divisum usually is a coincidental finding, and most individuals with this anomaly are asymptomatic.

It can be of clinical relevance in the following situations:

At endoscopic retrograde cholangiopancreatography (ERCP), the small ventral duct must be differentiated from various causes of main pancreatic duct cutoff, such as pancreatic cancer and pancreatic pseudocysts.
Dorsal pancreatic duct diseases can be missed because only the ventral portion of the pancreas can be viewed via standard major papilla cannulation.
Patients with symptomatic pancreas divisum present with pancreatitis or chronic abdominal pain. Pancreatitis can be acute recurrent pancreatitis or chronic pancreatitis. Patients with chronic abdominal pain can have a pain syndrome consistent with pancreatitis without an identifiable etiologic cause for pain (serum amylase, lipase, and imaging findings are normal).

Physical examination

The findings from an abdominal examination usually are normal. Epigastric tenderness and a palpable pseudocyst might be present during episodes of pancreatitis.

Differential Diagnoses

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Media Gallery

Pancreatic divisum. Cholangiopancreatogram showing small ventral duct (duct of Wirsung) and normal biliary tree upon cannulation of the major papilla
Pancreatic divisum. Pancreatogram showing the dominant dorsal duct (duct of Santorini) upon cannulation of the minor papilla

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Author

Rajan Kanth, MD Gastroenterologist, WellSpan Health

Rajan Kanth, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Nepal Medical Association, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Praveen K Roy, MD, MSc Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine

Praveen K Roy, MD, MSc is a member of the following medical societies: Alaska State Medical Association, American Gastroenterological Association

Disclosure: Nothing to disclose.

Mounzer Al Samman, MD Associate Clinical Professor, Department of Internal Medicine, Touro University College of Osteopathic Medicine; Attending Physician, Department of Medicine, NorthBay Health Care and Hospitals; Medical Director, Surgery Center at NorthBay VacaValley

Mounzer Al Samman, MD is a member of the following medical societies: American College of Gastroenterology, American Society for Gastrointestinal Endoscopy, American Gastroenterological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Marco G Patti, MD Surgeon, UNC Hospitals Multispecialty Surgery Clinic

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, Western Surgical Association

Disclosure: Nothing to disclose.

Acknowledgements

Mounzer Al Samman, MD Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Texas Tech University School of Medicine

Mounzer Al Al Samman, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association

Disclosure: Nothing to disclose.

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Pancreatic Divisum Clinical Presentation

History and Physical Examination

History

Physical examination

References

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