Abstract
A 59-year-old female was admitted because of the fifth attack of acute pancreatitis. The level of serum amylase was 6,616 IU/l. The patient had been previously diagnosed as having pancreas divisum on the basis of ERCP.
After acute pancreatitis subsided, minor papilla sphincterotomy (MiEST) and temporary stenting were performed. During the MiEST, the orifice of the minor papilla was not identified. The orifice was well demarcated using an infusion of 50 units of secretin, and the combination of spatular and conventional papillotomy knives facilitated the cutting and dilatation of the orifice. The inserted stent was expelled spontaneously 1 week later. The patient has been free of episodes of acute pancreatitis for 1 year and 2 months. The complications of pancreas divisum is classified into three groups, namely disabling chronic pancreatic pain ; acute recurrent pancreatitis (ARP) ; or chronic pancreatitis.
MiEST is most effective in the treatment of acute recurrent pancreatitis. In this case, the closure of the orifice was progressive. We believe that MiEST should be a first-line therapy for ARP in patients with pancreas divisum. Further, careful, long-term follow-up is necessary.
