Pancreas Divisum

What is pancreas divisum?

Pancreas divisum is a common and typically harmless malformation in your pancreas. It’s a congenital disorder (one you’re born with).

With pancreas divisum, the primary duct that drains your pancreas (pancreatic duct) doesn’t form complelety. As a result, the pancreatic juices that flow through this duct and help digest (break down) food will drain through a small opening rather than the larger opening. This leads to less efficient draining.

Most people don’t develop any symptoms from pancreatic divisum. But problems with drainage may lead to pancreatitis-like symptoms.

How common is pancreas divisum?

It’s the most common congenital disorder that affects the pancreas. About 10% of people in the general population have pancreas divisum.

How serious is pancreas divisum?

Pancreas divisum doesn’t cause problems for most people. Usually, it doesn’t limit your pancreas’s ability to help you digest food.

A small percentage of people with pancreas divisum experience severe symptoms of pancreatitis. Even then, symptoms usually aren’t serious enough to require surgery.

What are the symptoms of pancreas divisum?

The majority of people with pancreas divisum (more than 95%) don’t have symptoms. You can live your entire life without knowing you have this condition or being bothered by it.

When symptoms do arise, they’re the same as with pancreatitis. Symptoms include:

• Abdominal pain (most common).
• Nausea and vomiting.
• Fever.
• Indigestion.
• Loss of appetite.
• Fatty poops.
• Rapid heartbeat.
• Quick, shallow breathing.
• Lightheadedness (from low blood pressure).

What causes pancreas divisum?

Pancreas divisum occurs when your pancreas develops atypically before birth.

Typical pancreas development involves the fusion of two parts called “buds,” a ventral (front) bud and a dorsal (back) bud. Each bud has its own duct. Around week seven of pregnancy, these buds join to form a single organ, your pancreas. The ventral and dorsal ducts join, too, forming your pancreatic duct.

This duct is like the major pipeline that’ll someday drain digestive juices from your pancreas. The juice flows into the first part of your small intestine (duodenum) and aids in digestion.

With pancreas divisum, the two buds (and their ducts) don’t join in the typical way to form a pancreatic duct. Instead, you may have two separate, smaller ducts that drain your pancreas. Instead of draining through the large opening in your pancreatic duct (major papilla), the majority of your pancreatic juices may flow through a smaller opening that empties into the duodenum (minor papilla).

There are variations in terms of how the ducts eventually arrange themselves to drain your pancreas.

Complications of pancreas divisum

The biggest potential complication is pancreatitis. But the word “potential” is important here. It’s true that people with pancreas divisum sometimes have symptoms of pancreatitis. But scientists continue to research the relationship.

One theory is that pancreatic juices can become backed up if they can’t drain through the smaller opening (the minor papilla). The blockage may lead to inflammation. It’s also possible that, sometimes, these two conditions happen to occur together. After all, some people with pancreas divisum have pancreatitis, but most don’t. Another theory is that pancreas divisum may increase the likelihood of developing pancreatitis — but only in some instances.

More research is needed to know for sure.

How is it diagnosed?

Providers usually notice pancreas divisum during an abdominal CT scan (computed tomography scan) for an unrelated issue.

If you’re experiencing symptoms, your provider may order:

• Magnetic resonance cholangiopancreatography (MRCP): This test allows your provider to see your pancreatic duct system on a screen. You’ll receive an injection that causes your pancreas to release a hormone called secretin. The secretin causes any irregularities (like pancreas divisum) to stand out more on screen. Sometimes, providers perform this test without secretin injection.
• Endoscopic ultrasound: This test uses a scope to produce ultrasound images of your organs on a screen. It can show if you have inflammation in your pancreas.
• Endoscopic retrograde cholangiopancreatography (ERCP): This test uses a scope and X-rays to record images of your pancreatic duct system. A provider sends the scope down your throat and into your pancreas. The scope releases a safe dye that helps your ducts show up on screen. It’s like MRCP but more invasive. For this reason, providers typically only use this procedure if they know they’ll provide endoscopic treatments (endoscopy). These treatments use a scope to help perform the procedure.

What is the treatment for pancreas divisum?

Most people with pancreas divisum don’t need treatment.

Your healthcare provider can recommend ways to manage symptoms of mild to moderate pancreatitis. They may recommend:

• Switching to low-fat meals: Choosing low-fat foods cuts back on the work your pancreas has to do to process hard-to-digest fat.
• Taking medications. You may need to take a pain reliever, such as an analgesic.
• Taking supplements. You may need to take pancreatic enzyme supplements to aid digestion.

If you have frequent or severe symptoms (like abdominal pain), you may need a procedure to help widen the pancreatic duct.

Specific procedures

Procedures that widen the minor papilla include:

• Endoscopy: Your provider can cut and enlarge the minor papilla opening during an ERCP. They may place a metal tube called a stent into the opening to keep it enlarged.
• Surgery: Most people don’t need surgery for pancreatic divisum. Still, you may need surgery if you’re not eligible for endoscopy or if you had endoscopy in the past and it failed to work. For this procedure, your provider makes an incision (cut) in your abdomen to access your pancreatic duct. Here, too, treatment involves widening the duct that allows pancreatic juices to drain into your small intestine.

What are the complications of treatment?

Your healthcare provider will assess your health before recommending a procedure. In general, complications are rare.

Potential complications include:

• Development of pancreatitis.
• Renarrowing of the minor papilla.
• Development of perforation, or bleeding.

What is the prognosis (outlook) for pancreas divisum?

Your outlook is excellent, especially if you don’t have symptoms. Pancreas divisum likely won’t impact your life at all.

Most people who do have symptoms can manage them without a medical procedure. If you need a procedure, endoscopy and surgery are both considered safe and effective options. They’re most effective if you have symptoms of acute or recurrent pancreatitis. They’re less effective at treating chronic pancreatitis.

What questions should I ask my healthcare provider?

Questions to ask include:

• How will having pancreas divisum affect my health?
• What’s the likelihood I’ll develop pancreatitis?
• What symptoms should I look out for?
• Are my symptoms likely related to pancreas divisum or a separate issue?
• Will I need treatment to manage my symptoms?

A note from Cleveland Clinic

Don’t be alarmed if you learn during an imaging procedure that you have pancreas divisum. It’s a common congenital disorder. If it’s not causing symptoms now, it likely won’t in the future. If you’re experiencing symptoms, follow your healthcare provider’s guidance on whether you can manage them with medications and supplements. If they’re recommending an endoscopy to widen your pancreatic duct, ask about the potential risks and benefits of treatment. They can guide you toward the best treatment options based on your health.