title: Pancreas Divisum in Children and Duodenum-Preserving Resection of the Pancreatic Head.
abstract: BACKGROUND
  A retrospective study was performed to evaluate the clinical features, diagnostic methods, and treatment alternatives in children with pancreas divisum (PD).
  
  
  METHODS
  Patients who underwent treatment for PD between 1999 and 2014 at our department were evaluated for sex, age, presenting symptoms, physical examination findings, biochemical markers, diagnostic methods, treatment modalities, and results of treatment during follow-up.
  
  
  RESULTS
  Seven patients who underwent treatment of symptomatic PD were included in the study. The median for follow-up period was 8 years (from 26 months to 16 years). Male-to-female ratio was 4:3 and the median age at presentation was 11 years (2-14 years). Presenting symptoms were recurrent episodic epigastric pain. Pancreatitis was documented by elevated amylase or lipase levels. Endoscopic retrograde cholangiopancreatography (ERCP) was the method of diagnosis of PD in all patients. Five patients had complete PD and two had incomplete variants. Three patients improved after ERCP papillotomy. In three patients, papillotomy was unsuccessful but they have only mild episodes of pancreatitis. One patient presented at the age of 4 years with recurrent pancreatitis. She was treated surgically by duodenum-preserving resection of the pancreatic head (DPRPH) because of severe recurrent pancreatitis occurring even after ERCP papillotomy. The patient is 26 months after operation without any reported problems.
  
  
  CONCLUSIONS
  Patients with symptomatic PD are indicated for ERCP papillotomy attempt. If there is not improvement after ERCP, then recurrent bouts of severe pancreatitis are considered as an indication for surgical procedure. DPRPH is a safe and feasible surgical alternative.
authors.affiliation: Department of Paediatric Surgery, Institute of Postgraduate Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic.|Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Snajdauf
authors.affiliation: Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Petru
authors.affiliation: Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Nahlovsky
authors.affiliation: Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Rygl
authors.affiliation: Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Barbora
authors.initials: B
authors.lastname: Frybova
authors.affiliation: Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Bronsky
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mixa
authors.affiliation: Department of Internal Medicine, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic.
authors.forename: Radan
authors.initials: R
authors.lastname: Keil
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004386:Duodenum; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010179:Pancreas / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome