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Pancreas divisum: opinio divisa
  1. L QUEST,
  1. Royal Liverpool University Hospital
  2. Prescot Street, Liverpool L7 8XP, UK

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“Pancreas divisum” describes the congenital anomaly in which the dorsal and ventral pancreatic glands drain separately into the duodenum. It occurs due to failure of fusion of the dorsal and ventral ducts during the seventh week of gestation and is characterised not only by the anatomical configuration but also by the physiology of duct drainage—that is, predominant drainage through the dorsal duct of Santorini.1 The pancreas gland arises during the fifth week of gestation from three outgrowths of the primitive duodenum.2 ,3 The dorsal pancreatic bud grows at first posteriorly in the midline and later comes to lie in the concavity of the duodenum. Two ventral buds develop slightly caudal to the dorsal bud and the left bud later atrophies but rarely persists to become an annular pancreas. The right ventral bud develops in association with the primitive bile duct. Later the ventral pancreas rotates posteriorly until it comes to lie on the left of the duodenum, caudal to the dorsal pancreas. The duct systems then usually fuse together, the dorsal duct forming the main duct of the body and tail while the ventral duct (Wirsung's duct) becomes the main conduit for pancreatic secretion coursing through the head and opening into the major papilla in the duodenum. The dorsal duct usually also continues to drain along its original course in the duct of Santorini through the minor or accessory papilla which opens in the duodenum proximal to the major papilla.

The discovery of pancreas divisum is usually attributed to Joseph Hyrtl (anatomist, 1810–1894), although it had been described previously in the seventeenth century. Three variants have been described1 ,4: type 1 or classical divisum in which there is total failure of fusion; type 2 in which dorsal drainage is dominant in the absence of …

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