Summary
Pancreatic exocrine and endocrine function is described in 29 patients with pancreas divisum and upper abdominal pain. The diagnosis was made by endoscopic pancreatography (ERP) after cannulation of the major, as well as the accessory, papilla in all patients. At ERP, six patients had signs of marked and six patients moderate pancreatitis, whereas 17 patients were free from pancreatitis changes. Pancreatitis was found in the dorsal anlage in 12 patients (41%) of whom seven (24%) had similar alterations also in the ventral anlage. Fecal fat excretion was increased in 48% of the patients, and abnormal serum levels of pancreatic enzymes were found in more than one-third. Impaired insulin release was detected in 21% of the 28 patients examined following ingestion of oral glucose. Including an additional patient with manifest diabetes, 24% (7/29) had signs of endocrine insufficiency. The serum-insulin, serum-C-peptide and insulin/glucose pattern following an oral glucose load reflected the degree of severity of pancreatitis changes at ERP. Altogether, 66% of the patients had morphological and/or functional evidence of pancreatic affection.
Similar content being viewed by others
References
Rösch W, Koch H, Schaffer O, Demling L. The clinical significance of pancreas divisum. Gastrointestinal Endoscopy 1976; 22: 206–209.
Gregg JA. Pancreas divisum: its association with pancreatitis. Am. J. Surg. 1977; 134: 539–543.
Kruse A. Pancreas divisum: a significantly higher incidence in chronic pancreatitis? Scand. J. Gastroentrol. 1977; 12 (Suppl 45): 52.
Cotton PB. Congenital anomaly of pancreas divisum as cause of obstructive pain in pancreatitis. Gut 1980; 21: 105–114.
Richter JM, Schapiro H, Mulley AG, Warshaw AL. Association of pancreas divisum and pancreatitis, and its treatment by sphincteroplasty of the accessory ampulla. Gastroenterology 1981; 81: 1104–1110.
Sahel J, Cros RC, Bourry J, Sarles H. Clinico-pathological conditions associated with pancreas divisum. Digestion 1982; 23: 1–8.
Cotton PB. Pancreas divisum—curiosity or culprit? Gastroenterology 1985; 88: 1431- 1435.
Delhaye M, Engelholm L, Cremer M. Pancreas divisum: congenital anatomic variant or anomaly? Gastroenterology 1985; 89: 951–958.
Sarner M, Cotton PB. Classification of pancreatitis. Gut 1984; 25: 756–759.
Rauschner E, von Bülow S, Neumann U, Schaich E. Determination of the activity of α-amylase by continuous monitoring with 4-nitrophenyl-α, D-maltoheptoside as substrate. Ber Österr Ges Klin Chemie 1981; 4: 150.
O’Donnell MD, Fitzgerald O, McGeeney KF. Differential serum amylase determination by use of an inhibitor, and design of a new procedure. Clin. Chem. 1977; 23: 560–566.
Ziegenhorn J, Neumann U, Knitsch KW, Zwez W. Determination of serum lipase. Clin. Chem. 1979; 25: 1067.
van de Kamer JH, Huinink B, Weyers HA. Rapid method for the determination of fat in faeces. J. Biol. Chem. 1949; 177: 347–355.
Arnqvist H, Olsson PO, von Schenck H. Free and total insulin as determined after precipitation with polyethylene glycol: analytical characteristics and effects of sample handling and storage. Clin. Chem. 1987; 33: 93–96.
Heding LG. Radioimmunological determination of human C-peptide in serum. Diabetologia 1975; 11: 541–548.
von Schenck H. Radioimmunoassay of glucagon. Larner J, Pohl SL, eds, Methods in diabetes research, Wiley, New York, 1984; 327–345.
Oral glucose tolerance test. WHO Technical Report Series 727, Geneva, 1985; pp. 10–13.
Soehendra N, Kempeneers, J, Nam VC, Grimm JJ. Endoscopic dilatation and papillotomy of the accessory papilla and internal drainage in pancreas divisum. Endoscopy 1986; 18: 129–132.
Möllmann KM, Bonnevie O, Gudmand-Höjer E, Wulff HR. A diagnostic study of patients with upper abdominal pain. Scand. J. Gastroenterol. 1975; 10: 805–809.
Horrocks JC, De Dombal FT. Clinical presentation of patients with “dyspepsia.” Gut 1978; 19: 19–26.
Harvey RF, Salih SY, Read AE. Organic and functional disorders in 2000 gastroenterology outpatients. Lancet 1983; i: 632–634.
Worning H. Exocrine pancreatic function in dyspepsia. Digestion 1987; 37, suppl 1: 3–13.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lindström, E., von Schenck, H. & Ihse, I. Pancreatic exocrine and endocrine function in patients with pancreas divisum and abdominal pain. Int. J. Pancreatol. 6, 17–24 (1990). https://doi.org/10.1007/BF02924340
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02924340