Ventral pancreatitis in a patient with pancreas divisum.
Pancreas divisum results in drainage of most pancreatic secretions through the minor papilla via the dorsal duct, and the association of minor papilla stenosis has been implicated as a cause of pancreatitis. Most of the reported cases represent pancreatitis confined to the dorsal part. The authors treated a 10-year-old boy with recurrent pancreatitis that was substantially more severe in the ventral part. The patient was referred with a brief history of abdominal pain and had undergone a laparotomy when segmental ventral pancreatitis had been observed. Severe pancreatitis and acute renal failure developed, which required drainage of the lesser sac and hemodialysis, respectively. After 5 months, he had another episode that subsequently led to a pseudocyst in the ventral part. Endoscopic retrograde cholangiopancreatography via minor papilla showed a normal-caliber dorsal duct communicating with a part of the fine ventral ducts. A normal biliary tree was shown, but no ventral duct was visualized by cannulation to the major papilla of Vater. Dual sphincteroplasties and a cholecystectomy were performed. The minor papilla was stenotic and admitted only the finest lacrimal duct probe. The orifice of the ventral duct could not be observed. Thus it was clarified that the dorsal duct with its stenotic orifice had drained both the dorsal and ventral pancreas. The patient has remained asymptomatic over 36 months postoperatively. Despite their limited experience, the authors believe that (1) this anatomic variant led to ventral pancreatitis, and (2) the sphincteroplasty of the minor papilla was successful.