Treatment of pancreatitis associated with pancreas divisum by dorsal duct sphincterotomy alone

Of 480 patients seen with pancreatitis at the Sunnybrook Medical Centre, Toronto, in the past 5 years, 5 had pancreas divisum, demonstrated by pancreatography. Clinical presentations included recurrent acute pancreatitis, chronic pancreatitis and recurrent subcutaneous fat necrosis with steatorrhea. Pancreatography demonstrated dorsal pancreatic drainage through the duct of Santorini in all cases. The luminal diameter at the orifice of the duct of Santorini, assessed at operation, was inadequate to provide normal drainage from the gland. Sphincterotomy of the duct of Santorini alone, without surgery to the duct of Wirsung or sphincter of Oddi, was performed in four patients. This relieved the pain of chronic pancreatitis, eliminated recurrent attacks of acute pancreatitis and curtailed recurrence of subcutaneous fat necrosis and steatorrhea during follow-up periods of 51, 27, 17 and 28 months respectively. One patient who refused operation continued to have recurrent pancreatitis 41 months after diagnosis.