Pseudo-divisum of the pancreas - A source of diagnostic confusion
Background: The abrupt termination of the ventral pancreatic duct due to local pathology is sometimes mistaken for pancreas divisum. This so called "pseudodivisum" anatomy has implications for patient management, especially the timely identification of malignancy. Purpose: To identify (1) specific radiologie criteria for differentiating pseudodivisum from pancreas divisum, and (2) common characteristics among patients diagnosed with pseudo-divisum anatomy. Methods: All patients with the finding of pseudo-divisum between September 1991 and October 1997 were identified through a retrospective search of our endoscopy database. ERCP films were reviewed and correlated with CT images, when available. The patients' medical records were reviewed for demographic data, as well as presenting complaints, actual pathology identified, and final diagnosis. Results: Nine patients demonstrated findings consistent with pseudo-divisum. Six were male. Seven presented with abdominal pain; mean age 51 years (range = 31 to 72). None was recognized as having pseudo-divisum anatomy prior to referral. The underlying pathologies were tumor (four patients) and chronic pancreatitis in five patients (three with duct obstructing pancreatic stone disease, one with inflammatory mass, and one with pseudocyst). Conclusions: 1. Findings useful in differentiating pseudo-divisum from pancreas divisum are: a) a blunt cut-off of the ventral duct without typical arborization, b) cross sectional imaging demonstrating a mass/lesion at the site of the duct cut-off, and c) visualization of the dorsal pancreatic duct revealing no communication with the duct of Wirsung. 2. The most common presenting complaint in pseudo-divisum is pain; tumor and chronic pancreatitis were the most common causes of pseudo-divisum in this study. 3. Findings of a ventral duct with the above characteristics at ERCP warrant minor ampullary cannulation or other imaging.
Branch, MS; Swartz, K; Enns, R; Baillie, J; Jowell, P
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