Severity of Acute Gallstone Pancreatitis in Patients with Pancreas Divisum

Background and Study Aims: The presence of pancreas divisum may reduce the severity of acute gallstone pancreatitis (AGP), as stone impaction at the major papilla only affects the ventral pancreas.
Patients and Methods: The severity of AGP was compared retrospectively in patients with and without pancreas divisum. Acute gallstone pancreatitis was defined by clinical, biological, radiological, and endoscopic features. Thirteen patients with AGP and pancreas divisum were identified among those presenting with AGP between 1989 and 2000. Pancreas divisum patients were compared to 39 control individuals with AGP and conjugate pancreas. All patients underwent biliary sphincterotomy. Levels of serum amylases, lipases, C-reactive protein (CRP), and white blood cells (WBC) were compared in patients with AGP and pancreas divisum and in control individuals before sphincterotomy. The severity of pancreatitis was assessed on the basis of CRP, Ranson's score, computed tomography, the need for intensive care and drainage of collections or necrosis, duration of hospitalization, and mortality.
Results: Patients with AGP and pancreas divisum had a lower severity grade at CT scanning than control individuals (P = 0.005), a shorter hospitalization period (5 ± 1.9 vs. 11.6 ± 1.6 nights; P = 0.032), and lower mortality (none of 13 vs. four of 39; P = 0.048). Serum amylases and lipases, WBC, and Ranson's score tended to be lower in patients with AGP and pancreas divisum, but the difference was not significant in comparison with control individuals.
Conclusions: Acute gallstone pancreatitis is less severe in patients with pancreas divisum than in those with a conjugate pancreas.

References

• 1 Kleitsch W P. Anatomy of the pancreas: study with special reference to the duct system.  Arch Surg. 1955;  71 795-802
• 2 Lehman G A, Sherman S. Diagnosis and therapy of pancreas divisum.  Gastrointest Endosc Clin N Am. 1998;  8 55-77
• 3 Bret P M, Reinhold C, Taourel P. et al . Pancreas divisum: evaluation with MR cholangiopancreatography.  Radiology. 1996;  199 99-103
• 4 Cotton P B. Congenital anomaly of pancreas divisum as cause of obstructive pain and pancreatitis.  Gut. 1980;  21 105-114
• 5 Sahel J, Cros R C, Bourry J, Sarles H. Clinico-pathological conditions associated with pancreas divisum.  Digestion. 1982;  23 1-8
• 6 Liguory C, Lefebvre J F, Canard J M. et al . Le pancreas divisum: étude clinique et thérapeutique chez l'homme. A propos de 87 cas.  Gastroentérol Clin Biol. 1986;  10 820-825
• 7 Varshney S, Johnson C D. Pancreas divisum.  Int J Pancreatol. 1999;  25 135-141
• 8 Burtin P, Person B, Charneau J, Boyer J. Pancreas divisum and pancreatitis: a coincidental association?.  Endoscopy. 1991;  23 55-58
• 9 Delhaye M, Engelholm L, Cremer M. Pancreas divisum: congenital anatomic variant or anomaly?.  Gastroenterology. 1985;  89 951-958
• 10 Mitchell C J, Lintott D J, Ruddell W S. et al . Clinical relevance of an unfused pancreatic duct system.  Gut. 1979;  20 1066-1071
• 11 Sugawa C, Walt A J, Nunez D C. et al . Pancreas divisum: is it a normal anatomic variant?.  Am J Surg. 1987;  153 62-67
• 12 Quest L, Lombard M. Pancreas divisum: opinio divisa.  Gut. 2000;  47 317-319
• 13 Delhaye M, Engelholm L, Cremer M. Pancreas divisum: controversial clinical significance.  Dig Dis. 1988;  6 30-39
• 14 Devière J, Matos C, Cremer M. The impact of magnetic resonance cholangiopancreatography on ERCP.  Gastrointest Endosc. 1999;  50 136-140
• 15 Kozarek R A, Ball T J, Patterson D J. et al . Endoscopic approach to pancreas divisum.  Dig Dis Sci. 1995;  40 1974-1981
• 16 de Waele B, Peterson T, Willems G. Pancreas divisum: a protection against biliary pancreatitis? (letter).  Pancreas. 1995;  10 206-208
• 17 Grimaldi C H, Weisz M, Delmont J P. Pancreas divisum (letter).  Pancreas. 1991;  6 492-493
• 18 Meier C, de Manzini N, Rohr S. et al . Treatment of lithiasis of the common bile duct by endoscopic sphincterotomy and laparoscopic cholecystectomy.  Ann Chir. 1994;  48 31-36
• 19 Balthazar E J, Ranson J H, Naidich D P. et al . Acute pancreatitis: prognostic value of CT.  Radiology. 1985;  156 767-772
• 20 Bernard J P, Sahel J, Giovannini M, Sarles H. Pancreas divisum is a probable cause of acute pancreatitis: a report of 137 cases.  Pancreas. 1990;  5 248-254
• 21 van Laethem J L, Eskinazi R, Louis H. et al . Multisystemic production of interleukin 10 limits the severity of acute pancreatitis in mice.  Gut. 1998;  43 408-413