What is pancreatic divisum? symptoms and causes

September 12, 2024

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What is pancreas divisum? Symptoms and causes

Usually, patients are born with pancreas divisum. It is a common congenital disorder. In patients with pancreas divisum, the primary duct that drains the pancreas, called the pancreatic duct, does not form as it is expected to. Therefore, pancreatic juices that help break down and digest food drain through a smaller opening, as opposed to a larger opening. This drainage system is inefficient. Most people with pancreas divisum do not face any problems. But in some others the inefficient drainage system may cause symptoms that resemble pancreatitis.

What is pancreas divisum?

During the seventh week of pregnancy the dorsal and ventral buds must fuse in the pancreas of a foetus. This does not however happen in the case of patients with pancreas divisum. Resultantly, the pancreas drains into the minor papilla (instead of the major papilla) via the dorsal duct.

Now, in about 95% of the cases, people with pancreas divisum experience no symptoms. But the remainder of the population with this condition experience recurrent pancreatitis. Some of them develop a chronic condition too.

Symptoms of pancreas divisum

A majority of the people with pancreas divisum live their entire lives without knowing they have this condition. But when the symptoms do show up, they mirror those that indicate pancreatitis:

Severe abdominal pain.
Fever.
Indigestion.
Vomiting and nausea.
Loss of appetite.
Fatty poops, that is, excess fat in stool.
Rapid heartbeat and quick breathing.
Low blood pressure causing lightheadedness.

Cause of pancreas divisum

Pancreas divisum is caused by the atypical development of the pancreas in the womb.

Normally, the development of the pancreas involves the fusing of two parts called buds, the front (ventral) bud and the back (dorsal) bud. Each of these buds has its own duct. In the seventh week of pregnancy, normally, these two buds come together to form the pancreas. At this time, the two ducts join to form the pancreatic duct.

In patients with pancreas divisum, the two ducts do not join typically. Instead of a single pancreatic duct, patients with pancreas divisum may have two different, smaller ducts that drain the pancreas. Resultantly, the pancreatic juices may drain through a small opening, instead of draining through the larger pancreatic duct.

This atypical development of the pancreas, called pancreas divisum, leads to inefficient drainage of the organ.

Diagnosis and treatment

Pancreas divisum may often show up during a CT scan of the abdomen being done for another, totally unrelated, condition.

If the patient is reporting symptoms, additional tests may be ordered. These include:

Endoscopic ultrasound: This produces ultrasound images of the pancreas on a screen that can help detect inflammation in the pancreas.
Magnetic resonance cholangiopancreatography (MRCP): Through this test, the doctor will be able to see the entire pancreatic duct on a screen.
Endoscopic retrograde cholangiopancreatography (ERCP): Through a scope and X-rays the images of the pancreatic duct are recorded and examined.

There is usually no treatment attempted if the patient is not reporting any symptoms.

When the symptoms of pancreatitis are mild, the doctor may advise a treatment plan that includes:

Oral pain management medication.
Diet control with low-fat meals. This reduces the load on the pancreas.
Taking pancreatic enzyme supplements to improve digestion.

For severe cases, the doctor will attempt a procedure to widen the minor papilla, the small opening that is draining the pancreas currently. They may do this one of two ways:

Endoscopy: During ERCP, the doctor may make a small cut and enlarge the opening of the minor papilla. They may even place a stent at the opening. This will keep it enlarged.
Open surgery: The doctor will choose to perform an open surgery if endoscopy is not likely to suit the patient or if endoscopy has been attempted and has failed in the past. Even in this case, the doctor’s goal will be to enlarge the opening of the minor papilla.

Living with pancreas divisum

If there are no symptoms, there is nothing to bother about. A patient can live their entire life not knowing that they have pancreas divisum. People with symptoms can manage well without any serious medical intervention. In painful cases, both endoscopy and surgery are believed to be safe and worthwhile options to repair the condition. These options may not always work for chronic pancreatitis.

Conclusion

A patient without symptoms may discover that they have pancreas divisum when undergoing an imaging test for another condition. In such cases, no action or focus is required. Specifically, when no symptoms have shown up so far, there is a very low chance that they may show up the future. If the patient has symptoms, going through with the doctor’s advice is an efficient way to deal with this condition. Both endoscopy and open surgery work well for most patients.

Frequently Asked Questions

1.What is pancreas divisum?

Pancreas divisum is a common congenital disorder. In patients with pancreas divisum, the primary duct that drains the pancreas, called the pancreatic duct, does not form as it is expected to. Therefore, pancreatic juices that help break down and digest food drain through a smaller opening, as opposed to a larger opening. This drainage system is inefficient.

2.What are the symptoms of pancreas divisum?

A majority of the people with pancreas divisum live their entire lives without knowing they have this condition. But when the symptoms do show up, they mirror those that indicate pancreatitis. These include, severe abdominal pain, fever, indigestion, vomiting and nausea, loss of appetite, excess fat in stool, rapid heartbeat and quick breathing, and low blood pressure causing lightheadedness.

3.What causes pancreas divisum?

Pancreas divisum is caused by the atypical development of the pancreas in the womb.

4.What are the treatment options?

There is usually no treatment attempted if the patient is not reporting any symptoms. When the symptoms of pancreatitis are mild, the doctor may advise a treatment plan that includes oral pain management medication, diet control with low-fat meals and taking pancreatic enzyme supplements to improve digestion. For severe cases, the doctor will attempt a procedure to widen the minor papilla, the small opening that is draining the pancreas currently. They may do this using endoscopy or open surgery.