False Pancreas Divisum. Acquired Pancreatic Duct Obstruction Simulating the Congenital Anomaly

Eight patients with recurrent acute pancreatitis were found by ERCP to have foreshortening of the duct of Wirsung simulating the radiographic appearance of the congenital anomaly pancreas divisum. In contrast to 44 patients with true pancreas divisum, who were predominantly young (mean 32 years), nonalcoholic (42/44), and female (34/44), patients with false pancreas divisum were older (mean 48 years), male (7/8), and alcoholic (5/8). False pancreas divisum is most often an acquired obstructing lesion resulting from irremediable injury to the pancreatic duct during acute pancreatitis, often associated with pseudocyst formation and subsequent healing by scar at the site of duct injury. Appreciation of the radiographic differences between pancreatograms in true and false pancreas divisum and the different findings at operation allow for proper selection of therapy. Whereas accessory papilla sphincteroplasty appears to be effective for recurrent pancreatitis associated with true pancreas divisum, false pancreas divisum requires distal pancreatectomy or pancreaticojejunostomy to overcome the irreversible obstruction of the main pancreatic duct.