My 20-year-old daughter has pancreatitis. An ERCP showed that she has pancreatic divisum. What type of surgery can correct this problem? Will surgery prevent further pancreatitis pain? It will be several months before we can get an appointment with a surgeon to discuss this.

J.

Pancreas divisum is a common birth defect affecting the pancreas. Normally, the pancreas forms from the fusion of two masses of tissue in the abdomen of the developing fetus. Each mass has a duct that drains its secretions. When the masses come together to form the pancreas, the ducts fuse to form the final duct that drains the enzymes and fluids produced by this gland.

In pancreas divisum, there is either an incomplete fusion or lack of fusion of the two masses, and, thus, two ducts remain. One duct (the dorsal duct) drains the majority of the pancreas via a small opening known as the minor ampulla.

Studies have shown that recurrent attacks of pancreatitis (inflammation of the gland) occur more commonly in people with pancreas divisum than in the general population. The theory is that the minor ampulla is not wide enough to adequately drain the dorsal duct and can be temporarily obstructed, leading to pressure in the pancreas and inflammation.

Various approaches have been tried to treat this problem. The surgical approach involves opening up the minor ampulla and sewing it so that it stays open, a procedure known as sphincteroplasty. Less invasive procedures are done endoscopically. The tissue surrounding the minor ampulla can be cut, or a stent can be placed into the duct to prop it open. These are advanced procedures that should only be performed by experts in this field.

It must be emphasized that none of the procedures mentioned has been conclusively shown to be better than the others, and some patients do not get relief at all. If you are contemplating a surgical or endoscopic procedure, you should discuss the options with a surgeon and a gastroenterologist who have experience in this area.