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Pancreas divisum (PD) is the most common congenital anomaly in the pancreatic catheter system, reported to be 4% to 10%. Pancreatic duct splitting is when the ventral and dorsal pancreatic ducts do not fuse. The ventral pancreatic duct (Wirsung duct) drains only the ventral pancreas, while the vast majority of glands flow into the small nipple through the dorsal pancreatic duct (Santorini tube). Pancreatic division is often associated with localized dilation of the dorsal pancreatic duct end and a dorsal pancreatic duct cyst, associated with small nipple obstruction. Pancreatic division is generally asymptomatic, but people are more likely to develop chronic abdominal pain and pancreatitis than normal people. Diagnosis of pancreatic division relies on retrograde cholangiopancreatography.
MRCP shows high sensitivity and specificity for pancreatic division. MRCP after pancreatic secretion is helpful in diagnosing pancreatic division and dorsal pancreatic duct cysts. In dorsal dominant tube syndrome, the vast majority of glands are drained through the dorsal pancreatic duct, but there is still communication with the Wilson tube.
The main pancreatic duct and the paracreatic duct are named after two European anatomists, Johann Georg Wirsung and Giovanni Domenico Santorini, respectively.
Patient 63 years of age female, parapancreatic duct cyst combined with pancreatic division. MRCP shows cystic dilation (yellow arrow) at the end of the parapancreatic duct, which is not shown in the primary pancreatic duct.
Patient 54 years old female, parapancreatic duct cyst.
Patient in a 73-year-old male, main pancreatic duct cyst, end cystic dilation manifestations (yellow arrow).
In a 32-year-old female patient with acute recurrent pancreatitis, the pancreatic duct is opened at the small nipple, the common bile duct is opened in the large nipple, and the ventral and dorsal pancreatic ducts are not confluent.
Source 丨 Medical Imaging Club
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