Evaluation and treatment of the dominant dorsal duct syndrome (pancreas divisum redefined)

American Journal of Surgery
A L WarshawB Flavin-Warshaw

Abstract

The controversial association of pancreatitis and pancreas divisum was studied in 100 patients (77 women, 23 men, median age 35) with episodic acute pancreatitis (49%) or "pancreatic pain" (51%). Seventy-one had classic pancreas divisum (type 1); 23 had only a dorsal duct with an absent Wirsung's duct (type 2); and 6 had a filamentous connection between the two duct systems (type 3). Accessory papilla sphincteroplasty was performed in 88 patients, with a mean follow-up of 53 months. The orifice was stenotic at the mucosal level in 66 patients. Seventy percent of patients have shown improvement: 85% if the accessory papilla was stenotic, compared with 27% if it was not (p less than 0.0001); and 82% with discrete attacks, compared with 56% with chronic pain (p = 0.002). Judged against intraoperative calibration of accessory papilla orifice diameter, ultrasonography with secretin stimulation was 78% sensitive for accessory papilla stenosis, with 3% false-positive results. Ultrasonography with secretin stimulation was the best predictor of surgical success: positive = 92% success (attacks or pain) versus negative = 40% success (64% with attacks; 21% with pain). There have been seven restenoses with six reoperations. We conclude tha...Continue Reading

Citations

Mar 1, 1996·Pediatric Surgery International·T KoshinagaY Kurosu
Sep 1, 1995·Digestive Diseases and Sciences·R A KozarekS L Raltz
Sep 1, 2006·Current Treatment Options in Gastroenterology·J Steven Burdick, Edward Horvath
Feb 9, 2006·Abdominal Imaging·N J LeeM-G Lee
May 9, 2006·Abdominal Imaging·T KamisawaN Kamata
Oct 7, 2006·Surgical and Radiologic Anatomy : SRA·Tamara AlempijevicNada Kovacevic
Mar 14, 2007·Journal of Gastroenterology·Julius SpicakTomas Hucl
Sep 19, 2001·Current Treatment Options in Gastroenterology·Lehel SomogyiCharles D. Ulrich
Sep 19, 2001·Current Treatment Options in Gastroenterology·Asif Khalid, Adam Slivka
May 1, 1995·Journal of Pediatric Surgery·Y SanadaK Kumada
Mar 1, 1991·Baillière's Clinical Gastroenterology·J E Geenen, P Rolny
Dec 6, 2000·Annales de chirurgie·L HeyriesJ Sahel
Aug 28, 2004·Gastrointestinal Endoscopy·Steven D Klein, John P Affronti
Oct 9, 2004·Gastrointestinal Endoscopy·Steven D Klein, John P Affronti
Sep 2, 1999·The Surgical Clinics of North America·I D Norton, B T Petersen
Sep 2, 1999·The Surgical Clinics of North America·J R IzbickiT Kuechler
Jun 8, 2001·The Surgical Clinics of North America·R Pathak, A M Cooperman
Sep 7, 2000·Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver·J Glaser, K Stienecker
Nov 1, 2000·Surgery·A L Warshaw
May 19, 2000·Annals of Surgery·W W Neblett, J A O'Neill
Sep 10, 2003·Journal of Clinical Gastroenterology·Hyun Jun KimSung Koo Lee
Jul 1, 1992·Gut·P Watanapa, R C Williamson
Dec 24, 1998·Gut·J W ChenJ Toouli
Aug 15, 2000·Gut·L Quest, M Lombard
Jul 18, 2002·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Giancarlo Flati, Ake Andrén-Sandberg
Nov 24, 2006·Vojnosanitetski pregled. Military-medical and pharmaceutical review·Dragana Zivanović, Vojislav N Perisić
Sep 22, 2010·World Journal of Gastroenterology : WJG·Terumi KamisawaNaoto Egawa
Aug 16, 2013·World Journal of Gastroenterology : WJG·Deng-Bin WangMary A Turner
Jun 20, 2014·World Journal of Gastroenterology : WJG·Cheng-Lin WangWei-Xia Nie
Sep 23, 2010·African Journal of Paediatric Surgery : AJPS·B K LahotiR K Mathur
Apr 8, 2011·World Journal of Surgery·Lutz SchneiderJens Werner
Feb 1, 2012·Clinical Journal of Gastroenterology·Shigenori YamadaManabu Nakamura
Jan 19, 2016·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Lutz SchneiderThilo Hackert
May 13, 2008·Journal of the American College of Surgeons·Katherine A MorganDavid B Adams
Dec 7, 2007·The Surgical Clinics of North America·James A Madura, James A Madura
Nov 9, 2012·Journal of Digestive Diseases·Tarun Rustagi, Michael Golioto
Mar 10, 2004·American Journal of Surgery·Paul H JordanKaren L Woods
Jan 25, 2005·Annales de chirurgie·F DumontJ M Regimbeau

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