Recurrent idiopathic pancreatitis, suspected pancreas divisum
Recommended: MRCP (consider secretin-enhanced) is the preferred imaging study for recurrent idiopathic pancreatitis, suspected pancreas divisum. Failed fusion of ventral and dorsal ducts.
Recommended study
MRCP (consider secretin-enhanced)
Failed fusion of ventral and dorsal ducts. Majority of pancreas drains through small minor papilla.
If the default doesn't apply
Therapeutic option / equivocal MRCP
ERCP with minor papilla cannulation
IV contrast
Watch-outs
Most pancreas divisum is asymptomatic
Common variant (~10% population); only minority cause pancreatitis. Don't over-attribute symptoms.
Pearls
- Cross-over sign: dorsal duct crosses anterior to CBD at the level of papilla.
- Santorinicele: cystic dilation of dorsal duct at minor papilla.
- Minor papilla sphincterotomy for symptomatic patients with documented pancreatitis.