Pancreas Divisum An Infrequent Cause of Acute Pancreatitis in A Case

A 40-year-old female without history of alcohol consumption and medication suffered from persistent epigastralgia for four days and was admitted to our hospital. Elevated serum amylase and lipase levels were noted. She was admitted and treated under the working diagnosis of acute pancreatitis. Abdominal sonography showed normal common bile duct, but enlargement of the whole pancreas and mild main pancreatic duct dilatation without evidence of gallstone. CT demonstrated consistent findings of mild infiltration around the pancreatic tail and body with minimal fluid collection without any space-occupying lesion. Due to persistent symptoms for five days, MRCP was arranged that showed non-opacification of the ventral duct and dilatation of the dorsal duct that drained into the minor papilla. Pancreas divisum (PD) was diagnosed. She was discharged after 6 days of hospitalization with symptomatic and supportive therapy without ERCP or endoscopic intervention. PD is a congenital anomaly predisposing to acute pancreatitis. The diagnosis of PD requires a high level of suspicion, especially in younger patients without evidence of alcohol consumption, hyperlipidemia, or gallstone. Although ERCP can give definite diagnosis, MRCP is the diagnostic tool of choice because of its noninvasiveness and high resolution. The justification of the use of invasive therapeutic measures in PD patients with pancreatitis is still controversial. ( J Intern Med Taiwan 2008; 19: 531-535 )