Pancreas Divisum: On Life Support, But Not Quite Dead

Pancreas divisum, the failure of fusion of the dorsal and ventral pancreatic ductal systems in utero, is the most common congenital abnormality of the pancreas. The clinical significance of pancreas divisum is often considered when it is found in patients with idiopathic acute or recurrent pancreatitis. With increasing use of magnetic resonance imaging and magnetic resonance cholangiopancreatography in the past twenty years, the detection of pancreas divisum is increasingly common in patients undergoing cross-sectional imaging. Therapeutic interventions for patients with recurrent acute pancreatitis and pancreas divisum aim to relieve the relative obstructive pancreatopathy caused by a stenotic minor papilla. Developments in the study of the genetics of pancreatitis have fueled the debate as to whether pancreas divisum in itself causes pancreatitis. Some have argued that pancreas divisum is a bystander and that its role as an etiology of recurrent acute pancreatitis should be abandoned. Others have suggested that further study is needed in the understanding of the association of pancreas divisum with genetic mutations, such as cystic fibrosis transmembrane conductance regulator. Historically, the study of pancreas divisum has been limited to uncontrolled and observational studies with the level of evidence reviewed. This paper will review the anatomy, diagnostic and therapeutic modalities, and developments in the genetics of pancreas divisum to revive the discussion on this much-debated topic. Received December 2nd, 2016 Accepted February 08th, 2017