Zahid Niaz, Salman Bokhari, M lmran Anwar.
Pancreas Divisum - A Rare Cause of Recurrent Pancreatitis.
J Coll Physicians Surg Pak Jan ;10(12):481-3.

We report on the presentation and management of a case of recurrent acute pancreatitis due to a congenital anomaly pancreas divisum (PD). Abdominal ultrasound showed a grossly dilated duct and an endoscopic retrograde cholangiopancreatography (ERCP) typically showed a very small duct of Wirsung. Drainage through a lateral pancreatico-jejunostomy (LPJ) to effectively decompress the hypertensive pancreas resulted in an effective control of symptoms and significant improvement in the duality of life, by achieving pain relief, weight gain and decrease in steatorrhoea in our patient over a period of two-years.

CASE REPORT: An 18-year-old male presented with recurrent attacks of central upper abdominal pain, vomiting and fever for three y years. He had additional complaints of five to six frothy and offensive loose stools per day and failure to gain weight for two years. He had been under treatment of various physicians mainly for acid peptic disease with H2 receptor blockers and antacids. His previous biochemical investigations including blood sugar levels and oesophago-gastroscopies were repeatedly normal except for an episodic rise in the serum amylase levels ranging between 560-1600 IU/L during various attacks. This patient was clearly suffering from acute relapsing pancreatitis (ARP). An abdominal ultrasound examination revealed increased echogenicity of the pancreas with a ductal diameter of more than 6 mm (normal 2.03.5mm). There was no local mass or stone and the biliary tract was normal. A subsequent FRCP clinched the diagnosis of pancreas divisum. There was no visualisation of the minor papilla but a normal major papilla was cannulated and a very short, 2cm duct of Wirsung was demonstrated, terminating with arborisation. There was no visualisation of a duct in the body of the organ. Biliary tract was normal. A Roux-en-Y LPJ was performed. The dilated duct was localized by needle aspiration, laid open and anastomosed in two layers to the roux loop of jejunum in a side to side fashion. The patient`s postoperative recovery was excellent and a 24-month follow-up was very encouraging. There were no further attacks of pain, a 2-kg increase in weight in 12 weeks and a drop in stool frequency to 1-2 per day. The patient continues to do well.

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