False pancreas divisum: a complication of post-endoscopic retrograde pancreatography pancreatitis

In 29 patients with abdominal pain the diagnosis of pancreas divisum (PD) was verified by endoscopic retrograde pancreatography (ERP) via both the major and the minor papilla. Computed tomography (CT) was done in all patients to evaluate contour, volume, antero-posterior diameters and attenuation values of the gland in comparison with a normal reference series. Also, the validity of the CT grading of pancreatitis was assessed in comparison with ERP grading. Patients with PD had an increased cranio-caudal diameter of the pancreatic head (p<0.001). Further, the main pancreatic duct was visualized more often in patients with PD (p<0.01), who also had an increasing frequency of pancreatic calcifications (p<0.05). Otherwise there were no differences compared with the normal series. The observed reduction in the volume of the gland in patients with marked pancreatitis at ERP seemingly reflected the severity of inflammation. No cleavage between the dorsal and ventral anläge was identified. CT was found to be too unspecific to be of any use in grading of pancreatitis. In conclusion, CT findings in patients with PD are sparse, unspecific and preferably a reflection of pancreatitis, if present. ERP remains the ‘gold standard’ for the diagnosis.

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Proximal Migration of Pancreatic Duct Stent in Pancreas Divisum: Challenges in Retrieval and Review of the Literature

Case Reports in Gastrointestinal Medicine ◽

10.1155/2021/5531658 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Subash Ghimire ◽

Shri Jaikishan Ravi ◽

Mohammad Yousef ◽

Hafiz Khan

Keyword(s):

Pancreas Divisum ◽

Review Of Literature ◽

Review Of The Literature ◽

Endoscopic Retrograde Pancreatography ◽

Endoscopic Retrograde ◽

Minor Papilla ◽

Proximal Migration ◽

Pancreatic Duct Stent ◽

Pancréas Divisum ◽

Selective Cannulation

Pancreas divisum is the most common congenital malformation of the pancreas. Sometimes it is considered an etiology when patients present with recurrent episodes of pancreatitis. Endoscopic retrograde pancreatography (ERP) with selective cannulation of the minor papilla with sphincterotomy and stent placement are performed in these patients. Proximal migration of pancreatic stents in pancreas divisum is rare and challenging to manage. We describe a case of proximal migration of a pancreatic stent in a patient with pancreas divisum and perform a review of literature.

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Analysis of the Efficacy and Safety of Endoscopic Retrograde Cholangiopancreatography in Children With Symptomatic Pancreas Divisum

Frontiers in Pediatrics ◽

10.3389/fped.2021.761331 ◽

2021 ◽

Vol 9 ◽

Author(s):

Guixian Pan ◽

Kaihua Yang ◽

Biao Gong ◽

Zhaohui Deng

Keyword(s):

Risk Factors ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Pancreas Divisum ◽

Medical Center ◽

Statistical Significance ◽

Univariate Analysis ◽

Median Number ◽

Therapeutic Effects ◽

Endoscopic Retrograde ◽

Pancréas Divisum

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been increasingly performed in children with symptomatic pancreas divisum (PD).Aim: To investigate the safety and efficacy of ERCP in the treatment of children with symptomatic PD.Methods: We performed a retrospective analysis on children with PD who were treated with ERCP at Shanghai Children's Medical Center between June 2015 and May 2020. Pertinent patient, clinical and procedural data were collected to assess the therapeutic effects and identify the risk factors for post-ERCP pancreatitis (PEP).Results: Overall, 114 ERCPs were performed in 46 children with PD. With a median follow-up of 28.5 months (12–71 months), 40 (87.0%) children achieved clinical remission, the median number of acute pancreatitis episodes decreased from four times per year pre-operatively to once per year post-operatively (P < 0.001), and the nutritional score improved post-operatively (P = 0.004). The incidence of PEP was 7.9%, and female sex, stone extraction, and gene mutations were identified as possible risk factors for PEP on univariate analysis. However, there was no statistical significance on multivariate analysis (P > 0.05).Conclusion: Therapeutic ERCP is an effective and safe intervention for children with symptomatic PD.

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