Eur J Pediatr Surg
DOI: 10.1055/s-0037-1599838
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Pancreas Divisum in Children and Duodenum-Preserving Resection of the Pancreatic Head

Jiri Snajdauf
Department of Paediatric Surgery, Institute of Postgraduate Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
,
Ondrej Petru
Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
,
Jiri Nahlovsky
Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
,
Michal Rygl
Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
,
Barbora Frybova
Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
,
Jiri Bronsky
Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
,
Vladimir Mixa
Department of Anaesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
,
Radan Keil
Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic
› Author Affiliations
Further Information

Publication History

07 October 2016

30 January 2017

Publication Date:
29 March 2017 (eFirst)

Abstract

Introduction A retrospective study was performed to evaluate the clinical features, diagnostic methods, and treatment alternatives in children with pancreas divisum (PD).

Materials and Methods Patients who underwent treatment for PD between 1999 and 2014 at our department were evaluated for sex, age, presenting symptoms, physical examination findings, biochemical markers, diagnostic methods, treatment modalities, and results of treatment during follow-up.

Results Seven patients who underwent treatment of symptomatic PD were included in the study. The median for follow-up period was 8 years (from 26 months to 16 years). Male-to-female ratio was 4:3 and the median age at presentation was 11 years (2–14 years). Presenting symptoms were recurrent episodic epigastric pain. Pancreatitis was documented by elevated amylase or lipase levels. Endoscopic retrograde cholangiopancreatography (ERCP) was the method of diagnosis of PD in all patients. Five patients had complete PD and two had incomplete variants. Three patients improved after ERCP papillotomy. In three patients, papillotomy was unsuccessful but they have only mild episodes of pancreatitis. One patient presented at the age of 4 years with recurrent pancreatitis. She was treated surgically by duodenum-preserving resection of the pancreatic head (DPRPH) because of severe recurrent pancreatitis occurring even after ERCP papillotomy. The patient is 26 months after operation without any reported problems.

Conclusion Patients with symptomatic PD are indicated for ERCP papillotomy attempt. If there is not improvement after ERCP, then recurrent bouts of severe pancreatitis are considered as an indication for surgical procedure. DPRPH is a safe and feasible surgical alternative.