# Chronic Pancreatitis and Pancreas Divisum: A Case Report of Recurrent Management Challenges

## TL;DR

A 46-year-old man with chronic pancreatitis due to pancreas divisum faced multiple hospitalizations before diagnosis, highlighting the need for early detection of congenital pancreatic anomalies.

## Contribution

This case emphasizes the importance of considering pancreas divisum in recurrent pancreatitis and the value of systematic diagnostic approaches.

## Key findings

- Pancreas divisum can cause chronic pancreatitis and is often misdiagnosed due to its subtle presentation.
- Non-invasive imaging like MRI is preferred for initial diagnosis, while endoscopic treatment is typically effective.
- Early recognition of congenital anomalies can prevent unnecessary interventions and delays in treatment.

## Abstract

Pancreas divisum, resulting from incomplete fusion of the pancreatic ducts during development, disrupts normal drainage and can lead to recurrent acute and chronic pancreatitis. This report presents a case of a 46-year-old male with chronic necrotizing pancreatitis secondary to pancreas divisum. The patient experienced multiple hospital admissions and underwent a cholecystectomy before the underlying etiology, pancreas divisum, was identified after six hospitalizations. This case highlights the diagnostic challenges of recurrent pancreatitis, emphasizing the importance of considering congenital pancreatic anomalies in patients with unexplained or refractory disease. It also underscores the need for a systematic approach to evaluating recurrent pancreatitis to avoid delays in diagnosis and unnecessary interventions. Pancreas divisum is associated with recurrent pancreatitis in a subset of patients. While endoscopic retrograde cholangiopancreatography remains the gold standard for diagnosis and intervention, non-invasive imaging such as magnetic resonance cholangiopancreatography is preferred for initial diagnosis. Endoscopic treatment, including minor papilla papillotomy and stenting, is typically effective for symptomatic cases. However, surgery may be necessary when these methods fail.