Pancreas divisum: How to treat and manage it
The pancreas is an organ that sits behind the stomach and secretes chemicals, called enzymes, which aid digestion. These digestive juices drain into the intestine through a tubular structure of ducts.
In normal circumstances, a person's digestive juices would drain to the small intestine through the ventral duct and via the major papilla. In pancreas divisum, however, they drain via the dorsal duct and the narrower minor papilla
Pancreas divisum is a widespread disorder, affecting 5 to 10 percent of the general population. The vast majority of people with the condition experience no symptoms, and most cases of pancreas divisum are only discovered after death, at autopsy.
- Most people will not experience any symptoms and may remain undiagnosed.
- Undiagnosed pancreas divisum means that sometimes digestive juices do not drain into the intestine efficiently, which impacts digestion.
- It is sometimes associated with choledochal cysts and intestinal malrotation, which are also abnormalities that occur in the womb.
- Pancreas divisum without symptoms does not require treatment.
How is it treated?
Usually, the ventral and dorsal duct fuse together as a fetus develops in the womb. In pancreas divisum, they remain seperate.
It does not usually require treatment.
If a person is in pain or experiencing frequent bouts of pancreatitis, doctors may suggest increasing the size of the opening to the minor papilla, which is the opening to the main pancreatic duct.
Doctors can achieve this in the following ways:
- Medical sphincterotomy: A gastroenterologist carries out this procedure during an endoscopy when the minor duct is identified and cut open.
- Surgical sphincterotomy: During this procedure, a surgeon cuts the minor duct open using a laser and is usually able to create an opening large enough for the digestive juices to drain through.
How can I manage it at home?
The National Pancreas Foundation has published the following lifestyle advice for people with pancreatic diseases:
- Follow a low-fat diet: An average-sized person should eat no more than 20 grams (g) of fat a day, and no single meal should contain more than 10 g of fat.
- Avoid alcohol and keep hydrated: Studies have shown dehydration causes the pancreas to flare up. Always have a bottle of water with you.
If someone experiences a flare-up of symptoms, they should limit their food intake. Speak to a doctor about the best way to do this.
What are the main symptoms?
Pain and bloating in the abdomen are potential symptoms of pancreas divisum.
Symptoms might include:
- abdominal bloating
- abdominal pain
- jaundice or yellowing of the skin
- food intolerance
- recurrent episodes of pancreatitis or inflammation of the pancreas
Very few people with the condition will develop any symptoms.
How is pancreas divisum diagnosed?
Pancreas divisum is usually diagnosed using magnetic resonance cholangiopancreatography (magnetic MRCP) or endoscopic retrograde cholangiopancreatography (ERCP).
These methods scan the inside of the body, and doctors will look for the presence of two separate rather than one fused pancreatic duct.
MRCP uses a powerful magnetic field and radio waves to produce detailed images of the pancreas and pancreatic ducts. It is non-invasive and does not require X-rays.
A person undergoing this test will likely be given a contrast material, which will be administered intravenously, through a drip. The person will then be asked to lie very still in the MRI machine while it scans the pancreas. The entire examination can take 10 to 45 minutes.
An ERCP is a camera and X-ray examination, during which a flexible tube with a tiny camera on the end is passed through the mouth into the stomach and the top of the small intestine.
Before taking X-rays of your pancreatic system, the doctor will inject a special dye that shows up on X-rays. The procedure usually takes 15 to 90 minutes.
What are the possible complications?
A potential complication of pancreas divisum is pancreatitis, which will require medical attention.
It occurs when the narrow pancreatic duct becomes blocked as the digestive juices find it difficult to drain into the small intestine. This causes swelling and damage to the tissue.
It usually begins with gradual or sudden pain in the top of the belly, sometimes extending to the back, which may get worse after eating.
The pain tends to be severe and constant and can last for several days without treatment. Medical attention is needed in most cases.
Other symptoms include:
Acute pancreatitis is treated with fluids, nutritional support and pain control. Doctors will also attempt to identify and deal with the underlying cause, which could be pancreas divisum.
What is the outlook?
Pancreas divisum is an abnormality that occurs in the womb, and as such cannot be prevented. However, the overwhelming majority of people with pancreas divisum do not experience any symptoms, and the condition will have no impact on their life.
For those who are impacted by pancreas divisum, it is essential to speak to a doctor about the available treatment and management options.