A Case of Late Presentation of Pancreatic Divisum in a Patient with Recurrent Pancreatitis

Abstract

Pancreatic Divisum (PD) is the most common congenital variation of pancreatic duct anatomy, arising when embryological ventral and dorsal endodermal buds fail to fuse (“classic” PD) or only fuse partially (“incomplete” PD). Most patients with PD are asymptomatic, but a subgroup of patients can present with recurrent bouts of pancreatitis. While alcohol and gallstones are the common causes of acquired pancreatitis, PD is a congenital cause of pancreatitis. It is usually suspected in younger individuals with recurrent pancreatitis who also have a family history. Here, we present a rare case of PD in an older individual who presented with recurrent pancreatitis. He underwent cholecystectomy for suspected gallstone pancreatitis but continued to have episodes of pancreatitis. He had a history of alcohol abuse but denied use in the last one year. PD was detected later as the cause. Recurrent pancreatitis led to the development of a pseudocyst and pancreaticopleural fistula (PPF). Medical management improved the pseudocyst and PPF.