Any experience in managing a patient with pancreatic divisum with chronic pancreatitis.
Yes, I'd agree. If you let the patient progressive from recurrent acute attacks to established chronic pancreatitis, then you have missed the endotherapy "boat", although a drainage procedure, like a Puestow, may still help with drainage issues.
In patients with chronic pancreatitis, protein plugs that pass through the minor papilla may be responsible of temporary obstruction of the pancreatic duct and cause bouts of pancreatitis. Patients with CP and PD show a chronic disease and have an independent evolution from the presence or absence of obstruction of the final tract of the pancreatic duct (papilla minor). Exacerbations may be due to other causes, such as calculi and/or stenosis. In same studies, there is a good response to MiES performed in PD patients with PC (regarding the number of hospitalization pre- and post-treatment). The use, in some cases, of external shock-wave lithotripsy (ESWL) as adjuvant therapy may be helpful.
Absolutely agree with Raffaele and John - this is chronic pancreatitis with known etiology. Treat it as chronic pancreatitis. I am refer in these pts to gastroenterologists for ERCP and papillotomy if ducts are undiluted. In pts with dilated ducts there is no time to loose and I proceed directly with surgery. There is a lot of high grade evidence that CP is best controlled by surgery regarding both the clinical complaints and the exocrine and endocrine function. So it is easy to made argumented and evidence based decision how to treat this patient.
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