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Karl Clebak 3.27.2008 http://images.main.uab.edu/healthsys/ei_0054.gif 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. Pancreas Divisum Normal 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. Normal Pancreatic Anatomy 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 Dorsal Pancreatic bud After clockwise rotation of the ventral bud Ventral Pancreatic Bud around the caudal part of the foregut, there is fusion of the dorsal pancreas (located anterior) and ventral pancreas (located posterior). Finally, the ventral and dorsal pancreatic ducts fuse, and the pancreas is predominantly drained through the ventral duct, which joins the common bile duct (CBD) at the level of the major papilla. The dorsal duct empties at the level of the minor papilla. Pancreas Divisum Incidence/Prevalence: 1-11% at autopsy 2-6% at ERCP most common congenital lesion of pancreas Hx: Recurrent Acute Pancreatitis Chronic Pancreatitis Pancreas Divisum Diagnosis ERCP Treatment endoscopic retrograde sphincterotomy Prognosis Clinically insignificant References Mortele, K et al. “Multimodality Imaging of Pancreatic and Biliary Congenital Anomalies.” Radiographics. May 2006. Vol 26:3: 715-729. Klein SD, Affronti JP. “Pancreas divisum, an evidencebased review: part I, pathophysiology.” Gastrointest Endosc. 2004 Sep;60(3):419-25 Klein SD, Affronti JP. “Pancreas divisum, an evidencebased review: part II, patient selection and treatment.” Gastrointest Endosc. 2004 Oct;60(4):585-9. Pancreas divisum. Dynamed. Updated 2007 Jul 05 02:26 PM:Accessed 26 March 2008.