Pancreas divisum is the most common variant of human pancreas, occurring in nearly 10% of the population. This anomaly results from the failure of fusion of the dorsal and ventral pancreatic ducts, which usually occurs in the second month of fetal life. This results in the drainage of the main pancreatic duct (including the superior-anterior aspect of the head, the body and the tail) into the dorsal duct via the accessory papilla. The ventral duct, which drains the posterior-inferior aspect, joins the common bile duct and empties into the major papilla (Figure 10). The diagnosis of this condition is made by ERCP.

Most patients having this anomaly are symptom-free, although some reports have suggested a high incidence of abdominal pain and pancreatitis. It has been suggested that the relative stenosis of the accessory papillary orifice, the major outflow tract for pancreatic secretions, is the cause of problems.

Endoscopic sphincterotomy or transduodenal sphincteroplasty has been advocated as the operation of choice in these individuals. The results obtained with this intervention have been controversial. Some studies have reported a success rate of 90% in patients with pancreas divisum pancreatitis after two years, whereas other reports did not support such findings. From the available literature, surgical intervention in pancreas divisum is as controversial as its causative relationship in abdominal pain and pancreatitis.