False pancreas divisum: not a difficult diagnosis.

OBJECTIVE

To study the clinical and cholangiopancreatographic features in cases of false pancreas divisum.

METHODS

Six patients with pancreatic duct block to the right of the spine detected among 300 consecutive endoscopic retrograde cholangiopancreatograms (ERCP) done during April 1990 to March 1992 formed the basis of the study. The clinical and radiological features of these six cases of false pancreas divisum were analyzed.

OUTCOME MEASURES & RESULTS: The causes of false pancreas divisum were carcinoma of pancreas (3 patients), pancreatic trauma (2) and pancreatitis with infected pseudocyst (1). Three patients presented with obstructive jaundice and three with pain in the abdomen. On ERCP, the pancreatic duct length varied from 3.5 cm to 5.0 cm and the diameter ranged from 2.0-6.5 mm. Terminal arborization of pancreatic duct was absent in all cases. In both patients with pancreatic trauma there was displacement of the pancreatic duct towards the common bile duct. A branch to the uncinate process originating from the main pancreatic duct was seen in 4 patients and contrast spilling at the site of block was seen in two patients.

CONCLUSION

History of abdominal trauma; demonstration of space occupying lesion in the pancreas; displaced, dilated pancreatic duct which terminates without arborization with or without leakage of contrast; and presence of a branch to the uncinate process arising from the pancreatic duct on pancreatography strongly suggest a diagnosis of false pancreas divisum.