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.