Introduction:
The pancreas is a long, flat organ behind the stomach and small intestine that secretes digestive enzymes and regulates blood sugar. A pancreas divisum is a birth defect in which parts of the pancreas do not join together. Pancreas divisum is a widespread condition affecting 5 to 10 percent of the general population. Pancreas divisum is the most common congenital anomaly of the pancreas and the most common anatomic variation of the pancreatic duct system.
What Are the Types of Pancreas Divisum?
The pancreas divisum is divided into complete and incomplete pancreas divisum. Complete pancreas divisum is the complete separation of the pancreatic duct system. An incomplete pancreas divisum has inadequate communication between the ventral and dorsal pancreatic ducts, usually an extremely small branch.
What Is the Cause of Pancreas Divisum?
The cause of the defect is unknown. In many cases, the defect goes unnoticed and causes no problems. Pancreas divisum is hereditary. The human embryo begins life with two pancreatic ducts: the dorsal and ventral. Normally, the two ducts fuse to form one main pancreatic duct. Fluid and digestive juices pass through this pancreatic duct.
When they do not fuse during embryogenic development at approximately eight weeks of intrauterine life, it results in pancreas divisum. The digestive juices and enzymes drain into the small intestine through the ventral duct and the major papilla. In the pancreas divisum, they drain through the dorsal duct and visa the minor papilla. Fluids from two parts of the pancreas drain separately.
What Are the Symptoms of Pancreas Divisum?
Most individuals born with pancreas divisum will not have any symptoms, and most cases of pancreas divisum are discovered after death during autopsy. The symptoms are due to pancreatitis and not due to pancreas divisum alone.
Some symptoms of pancreas divisum include:
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Abdominal pain, most often in the upper abdomen.
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Nausea.
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Vomiting.
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Abdominal swelling.
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Jaundice or yellowing of the skin.
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Food intolerance.
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Recurrent episodes of pancreatitis (inflammation of the pancreas).
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Sometimes, the pancreas divisum is associated with abnormalities in the womb, like choledochal cysts and intestinal malrotation.
What Is the Diagnosis of Pancreas Divisum?
The following tests are done for the proper diagnosis of pancreas divisum:
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Magnetic Resonance Cholangiopancreatography: This test uses a magnetic field and radio waves to produce clear images of the pancreas and pancreatic ducts. A contrast material is given while taking the test. It is a non-invasive procedure and does not require x-rays.
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Endoscopic Retrograde Cholangiopancreatography: In this procedure, a long, thin, flexible tube (endoscope) is inserted through the mouth into the stomach. A dye is injected, and x-rays of the pancreatic system are taken.
In these tests, the doctors will look for two separate ducts rather than one fused duct.
Other tests used for the diagnosis of pancreas divisum are:
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Blood Test: Amylase and lipase enzymes are elevated in the blood test when the pancreas is damaged.
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Computed Tomography (CT) Scan: This test uses a combination of x-rays and computer images to show detailed images of the inside of the body.
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Magnetic Resonance Imaging (MRI): They use magnetic and radio fields to create images of the organs and tissues.
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Endoscopic Ultrasound: This procedure combines the use of sound waves and endoscopes. It is a useful diagnostic tool for the evaluation of acute pancreatitis.
If the pancreas divisum is undiagnosed, sometimes digestive juices do not drain into the intestine properly, impacting the digestive process.
How Is Pancreas Divisum Treated?
Asymptomatic patients of pancreas divisum do not require treatment. In mild cases, the treatment focuses on a low-fat diet, relieving pain, and supplementing pancreatic enzymes. If symptomatic, the doctor might do surgery to enlarge the size of the opening of the minor papilla to allow normal flow of pancreatic enzymes.
This is done in two ways:
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Medical Sphincterotomy: It is done through endoscopy in which the minor duct is identified, and the opening is cut open.
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Surgical Sphincterotomy: The surgeon cuts the minor papilla opening through a laser and creates a large opening for the digestive enzymes. A stent may be inserted into the duct to ensure the duct will not cause blockage.
The complications of this surgery include acute or chronic pancreatitis and, in rare cases, kidney failure or death. Many studies have investigated the association between pancreas divisum and malignancy. Some studies report a higher risk of pancreatic adenocarcinoma associated with pancreatic divisum.
What Are the Complications of Pancreas Divisum?
The major complication of the pancreas divisum is acute or recurrent pancreatitis. It occurs when the narrowed pancreatic ducts become blocked, and the digestive juices cannot drain into the small intestine. This causes pain and swelling. The pain is usually gradual and suddenly starts at the top of the belly and worsens after eating. Acute pancreatitis is treated with fluid intake, painkillers, and nutritional support.
How Can We Prevent Pancreas Divisum?
Since the condition is present at birth, there is no way to prevent pancreas divisum.
What Are the Home Remedies for Pancreas Divisum?
The national pancreas foundation has given the following lifestyle advice for people with pancreatic diseases:
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Low-Fat Diet: Follow a low-fat diet with no more than 20 grams of fat a day.
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Avoid Alcohol Consumption: If you have pancreatic disease, you should never drink alcohol. Alcohol causes direct injury and inflammation of the pancreas.
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Temporary Fasting: Limiting food intake is sometimes necessary to rest the inflamed pancreas.
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Avoid dehydration by drinking lots of water.
Conclusion:
Pancreas divisum is an abnormality that occurs in the womb. The condition will not impact life, and many people will not even know they have this condition. Most people remain asymptomatic, and the prognosis is excellent.
