Pancreas divisum. Detection and management

J. A. Madura, A. C. Fiore, K. W. O'Connor, Glen Lehman, R. L. McCammon

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Pancreas divisum is a variant of pancreatic ductal drainage. Its existence is being observed more frequently with the widespread use of endoscopic retrograde cholangiopancreatography (ERCP). On occasion, a relative stenosis of the accessory sphincter will cause a symptom complex which includes nausea, vomiting, upper abdominal pain, and intermittent pancreatitis. In 20 patients seen over the past 4 years, symptoms have been severe enough to consider the patient for transduodenal sphincteroplasty. The use of morphine prostigmine stimulation as a screening tool, has been helpful in 79 per cent of the patients in the series. Intravenous secretin has been a valuable adjunct to both ERCP identification and cannulation of the duct, as well as in two patients whom the diagnosis was only suspected, and confirmed at the operating table. Operative common duct manometry has shown 40 per cent of the patients to have abnormal flow dynamics, suggesting possible disturbance in the biliary sphincter, as well as the accessory pancreatic sphincter. Pathologic examination has demonstrated abnormal gallbladders in nine of nine patients without previous cholecystectomy. The suggested procedure of dual sphinteroplasty has resulted in no mortalities, but a 50 per cent complication rate. Follow-up shows 70 per cent of the patients to be recurrent pancreatitis, and four patients have other problems causing continued post-operative pain. This study suggests dual sphincteroplasty is an acceptable form of therapy for patients with pancreatic divisum and no other source for their pain. Further follow-up will be necessary to insure that therapy is truly curative.

Original languageEnglish (US)
Pages (from-to)353-357
Number of pages5
JournalAmerican Surgeon
Volume51
Issue number6
StatePublished - 1985
Externally publishedYes

Fingerprint

Pancreas
Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Transhepatic Sphincterotomy
Operating Tables
Pain
Neostigmine
Secretin
Manometry
Cholecystectomy
Gallbladder
Catheterization
Morphine
Nausea
Abdominal Pain
Vomiting
Drainage
Pathologic Constriction
Mortality
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Madura, J. A., Fiore, A. C., O'Connor, K. W., Lehman, G., & McCammon, R. L. (1985). Pancreas divisum. Detection and management. American Surgeon, 51(6), 353-357.

Pancreas divisum. Detection and management. / Madura, J. A.; Fiore, A. C.; O'Connor, K. W.; Lehman, Glen; McCammon, R. L.

In: American Surgeon, Vol. 51, No. 6, 1985, p. 353-357.

Research output: Contribution to journalArticle

Madura, JA, Fiore, AC, O'Connor, KW, Lehman, G & McCammon, RL 1985, 'Pancreas divisum. Detection and management', American Surgeon, vol. 51, no. 6, pp. 353-357.
Madura JA, Fiore AC, O'Connor KW, Lehman G, McCammon RL. Pancreas divisum. Detection and management. American Surgeon. 1985;51(6):353-357.
Madura, J. A. ; Fiore, A. C. ; O'Connor, K. W. ; Lehman, Glen ; McCammon, R. L. / Pancreas divisum. Detection and management. In: American Surgeon. 1985 ; Vol. 51, No. 6. pp. 353-357.
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