Pancreas Divisum
Pancreas divisum is a common congenital variation in which the ducts of the pancreas fail to fuse during development. Instead of one main duct draining pancreatic enzymes into the small intestine, the pancreas drains through two separate ducts. Most people with pancreas divisum have no symptoms, but in some cases, it may be associated with abdominal pain or an increased risk of pancreatitis.
What is it?
Pancreas divisum occurs when the embryologic dorsal and ventral pancreatic ducts do not fuse into a single main duct. As a result, most pancreatic enzymes drain through the smaller dorsal duct and the minor papilla instead of the usual major papilla. This altered drainage pattern is typically harmless but may create higher ductal pressure in a small subset of people, potentially contributing to recurrent pancreatitis.
Imaging—especially MRI with MRCP—helps identify the configuration of the pancreatic ducts and assess for any associated inflammation or ductal dilation. CT scans can show complications of pancreatitis but are less detailed in visualizing the ducts themselves.
Important to Know
Most people with pancreas divisum never develop symptoms and do not need treatment. When symptoms occur, they are often related to pancreatitis, which may present with severe abdominal pain, nausea, or vomiting. In select cases, endoscopic procedures such as minor papilla sphincterotomy may improve drainage and reduce pancreatitis episodes.
Red flags include severe upper abdominal pain radiating to the back, persistent vomiting, fever, or signs of infection—these may indicate pancreatitis requiring urgent medical care. Follow-up imaging may be recommended if complications are suspected or to monitor recurrent symptoms.