Minor Papillotomy for Pancreas Divisum and Idiopathic Recurrent Pancreatitis

Given that the etiology of pancreatitis often remains idiopathic, many patients develop acute recurrent or even chronic pancreatitis that significantly affects their quality of life. A long-held belief was that the anatomical and morphological features of the pancreatic duct, particularly pancreas divisum, could play a role in the pathophysiology of recurrent pancreatitis. Pancreas divisum is a congenital condition in which the ventral and dorsal ducts fail to fuse, leading the smaller dorsal duct to provide drainage of the pancreas body and tail through the smaller duct of Santorini across the minor papilla instead of the usual drainage through the duct of Wirsung across the ampulla of Vater. The prevalence of pancreas divisum is estimated to be up to 10% in the general population and it is usually an incidental finding on radiographic imaging. Pancreas divisum is the most common congenital anomaly of the pancreatic duct and it is thought to increase the potential for duct obstruction via impaired drainage.