Pancreas divisum: CT scanning and ERCP correlation

Pancreas divisum (PD) is a congenital anomaly present in 6%-10% of the population. The author reviewed 19 cases of endoscopic retrograde cholangiopancreatographically (ERCP)-proved PD and correlated findings with CT appearances of the pancreas in 12 patients. Three independent observers blindly compared morphologic features with those of age-matched controls with normal ductal anatomy. Distinctive CT features were large axial and craniocaudal diameters of the pancreatic head (mean axial diameter, 3.2 cm for PD vs. 2.7 cm for controls; mean craniocaudal diameter: 5.4 cm vs. 4.4 cm, respectively; P < .05). CT examinations in six of 12 patients had been interpreted as showing enlargement of the pancreatic head. Two patients with biliary obstruction had carcinoma, one had ventral pancreatitis and three were healthy. The author conclude that a large pancreatic head with a long uncinate process suggests PD. Since PD may simulate a mass of the pancreatic head, ERCP should precede biopsy unless other evidence of malignancy is present