Pancreatitis in Patients with Pancreas Divisum

Introduction: Pancreas Divisum (PD) is a common anatomic variant that occurs when the dorsal and ventral pancreas do not fuse during gestation resulting in majority of the pancreatic secretions draining through the minor papilla. The clinical significance of PD is controversial. The goal of this study was to analyze risk factors for the development of pancreatitis in patients with PD. Methods: We retrospectively reviewed all patients with PD identified on any radiological study from 1997 - 2016 at three major tertiary institutions. Data collection on clinical encounters and risk factors for pancreatitis in these patients were identified. Patients with and without pancreatitis were compared by chi-square and ANOVA tests. A multivariable logistic regression model was performed. Results: There were a total of 284 patients with PD. 186 (65%) of these patients had acute or chronic pancreatitis, or both. Table 1 shows demographics and clinical variables of all patients with PD with and without pancreatitis. The mean age was younger for patients with pancreatitis (58.6 vs. 62.6 yrs, p= 0.04). 59.7% of patients with pancreatitis were females (p=NS). Of the patients with pancreatitis, 57.5% had recurrent acute pancreatitis (that is, 2 or more episodes of acute pancreatitis), 6.5% had chronic pancreatitis alone, 41.4% had both acute and chronic pancreatitis. A clinical diagnosis of pancreatitis was the most common reason for obtaining imaging in patients with pancreatitis (58%) while in patients without pancreatitis, other incidental reasons for obtaining imaging was the most common (58%).* The imaging modality most commonly used to identify patients with pancreas divisum was MRI of the abdomen (49.3%) and MRCP (36.3%). Patients with pancreatitis and PD were more likely to have a history of alcohol abuse, p = 0.02. Although, tobacco abuse tended toward significance, it was not significant (p=0.074). In a multivariable model among patients with PD to predict pancreatitis, younger age (odds ratio = 0.98 [95 % CI: 0.97 - 1; p=0.05]) and alcohol (odds ratio = 4.58 [95% CI: 1.03 - 20.35; 0=0.04]) were the only significant factors. Conclusion: In a cohort of patients with pancreas divisum, development of acute and chronic pancreatitis was associated with younger patient age and alcohol abuse. Pancreatic divisum may be an incidental finding in patients with pancreatitis, and patients with pancreas divisum should be strongly cautioned about alcohol use.Figure 1