Student SYB

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Student SYB

• Karl Clebak
• 3.27.2008

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http//images.main.uab.edu/healthsys/ei_0054.gif
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• Hx 47 yo male with persistently elevated amylase
  levels. Consumes 1 serving of alcohol per month.
  Denies history of pancreatitis. Past outside CT
  imaging has shown pancreatic duct dilation.

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Pancreas Divisum
Normal
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Official read

• PANCREATIC DUCT The main pancreatic duct was
  cannulated and contrast was instilled. Prominent
  accessory pancreatic duct was noted, measuring 8
  mm in greatest diameter. There is a filling
  defect in the distal accessory pancreatic duct as
  well, most consistent with a stone or an air
  bubble. Stents were placed in both the main
  pancreatic duct and the accessory pancreatic
  duct. No extravasation of contrast is noted.
• IMPRESSION
• Incomplete pancreas divisum, with the majority of
  drainage via the accessory duct.
• Filling defect in the accessory pancreatic duct
  most consistent with an air bubble or a stone.
• Stents placed in the main pancreatic duct and
  accessory pancreatic duct.

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Normal Pancreatic Anatomy
CBD
Duct of Wirsung drains into the Major Papilla.
Joins with the Common Bile Duct at the
Sphincter of Oddi. Duct of Santorini drains
intothe Minor Papilla
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Finally, the ventral and dorsal pancreatic ducts
fuse, and the pancreas is predominantly drained
throughthe ventral duct, which joins the common
bile duct (CBD) at the level of the major
papilla. The dorsal duct emptiesat the level of
the minor papilla.
Dorsal Pancreatic bud
After clockwise rotation of the ventral bud
aroundthe caudal part of the foregut, there is
fusion of the dorsal pancreas (located anterior)
and ventral pancreas (locatedposterior).
Ventral Pancreatic Bud
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Pancreas Divisum

• Incidence/Prevalence
• 1-11 at autopsy
• 2-6 at ERCP
• most common congenital lesion of pancreas
• Hx
• Recurrent Acute Pancreatitis
• Chronic Pancreatitis

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Pancreas Divisum

• Diagnosis
• ERCP
• Treatment
• endoscopic retrograde sphincterotomy
• Prognosis
• Clinically insignificant

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References

• Mortele, K et al. Multimodality Imaging of
  Pancreatic and Biliary Congenital Anomalies.
  Radiographics. May 2006. Vol 263 715-729.
• Klein SD, Affronti JP. Pancreas divisum, an
  evidence-based review part I, pathophysiology.
  Gastrointest Endosc. 2004 Sep60(3)419-25
• Klein SD, Affronti JP. Pancreas divisum, an
  evidence-based review part II, patient selection
  and treatment. Gastrointest Endosc. 2004
  Oct60(4)585-9.
• Pancreas divisum. Dynamed. Updated 2007 Jul 05
  0226 PMAccessed 26 March 2008.