Treatment of pancreas divisum
- Evan L Fogel, MD
Evan L Fogel, MD
- Professor of Medicine
- Indiana University School of Medicine
- Stuart Sherman, MD
Stuart Sherman, MD
- Professor of Medicine and Radiology
- Indiana University School of Medicine
- Glen Lehman Professor of Gastroenterology
- Director Of ERCP Services
- Clinical Director, Division of Gastroenterology and Hepatology
Pancreas divisum is the most common congenital pancreatic anomaly, occurring in approximately 7 percent of subjects in autopsy series [1,2]. More than 95 percent of patients with pancreatic divisum are asymptomatic, and it remains controversial whether the symptoms that occur in the remaining patients are due to pancreas divisum.
This topic will review the management of patients with pancreas divisum. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of pancreas divisum are discussed separately. (See "Pancreas divisum: Clinical manifestations and diagnosis".)
APPROACH TO MANAGEMENT
Due to the uncertainty of pancreas divisum as a causative factor in acute or chronic pancreatitis or chronic abdominal pain and the risks associated with treatment, our approach to the patient with pancreas divisum varies based on the clinical presentation.
Asymptomatic patients — Asymptomatic patients in whom pancreas divisum is incidentally found on abdominal imaging (eg, computed tomography scan or magnetic resonance cholangiopancreatogram [MRCP]) and who have no abnormality of the pancreas or clinical history of pancreatitis require no additional evaluation or treatment of pancreas divisum. (See "Pancreas divisum: Clinical manifestations and diagnosis", section on 'Diagnostic evaluation'.)
Patients with minimal/infrequent symptoms — In patients with pancreas divisum and mild or infrequent bouts of pain, we suggest conservative management rather than treatment of the minor papilla narrowing associated with pancreas divisum. Conservative management includes a low-fat diet, analgesics, anticholinergics, and if necessary, pancreatic enzyme supplements. The management of acute and chronic pancreatitis is discussed in detail, separately. (See "Management of acute pancreatitis" and "Treatment of chronic pancreatitis".)
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