Pancreas Divisum : An Infrequent cause of Acute Pancreatitis

Introduction: Pancreatic divisum (PD) is a condition that develops if the embryonic fusion of the dorsal and the ventral pancreas buds at the gestational age of 6 weeks is incomplete. The failure of fusion between these two pancreatic ducts results in a short and narrow duct in the head of the pancreas that drains through the major papilla (ventral duct) and a much longer duct that drains most of the pancreatic secretions through the minor papilla (dorsal duct).

The prevalence of PD has been reported to be approximately 7% to 12.6% in western populations and is the most common congenital pancreatic anatomical variant. On the other hand, it is relatively uncommon in Asia with an estimated incidence of less than 2% in the general population.

Case 1: Clinical History: A 16 years old female was admitted with findings of acute pancreatitis. Patient referred for plain 2D / 3D MR Cholangiopancreatography (MRCP).

Imaging Findings:

  • Dorsal pancreatic duct was seen to drain into duct of Sartorini and open in to the minor papilla.
  • Ventral duct was seen to open along with CBD into the major papilla.
  • A small channel was seen connecting these two ducts.
  • No ductal dilatation or intraductal calculi were noted.
  • Minimal soft tissue stranding of the peripancreatic fat was seen which was also seen to extend along the mesenteric vessels.
  • Minimal free fluid was noted in the pelvis.

Final Diagnosis: Pancreas Divisum (Type 3) with early changes of pancreatitis.