Pancreas Divisum

I'm a 44 year old female with a history of hypothyroidism and high blood pressure, but otherwise healthy.  Jan 1, 2009 I had an attack of stomach pain (center abdomen just below ribs and to my right).  The attack was horrible and wouldn't stop no matter what I took to try to relieve it (pepto, mylanta, tums, etc.).  After two weeks of off and on pain, diarrhea, nausea I decided to visit my internist.  Initially she thought pancreatitis, but after blood work she decided that must not be it.  But, the pain (in episodes) kept happening - I couldn't eat or sleep - it was terrible.  After a CT w/ dye the radiologist noted that I had a pancreas divisum.  Now, after about 4 weeks of this pain I had to be hospitalized because nothing was taking this pain away (it wasn't constant, but every few days it hit again and then would last for several days).  By the time I was admitted I had lost 10lbs.  In the hospital my calcium was high, magnesium low, but amylase and lipase normal.  Now, 5 months later I'm still suffering - again, not constant, but consistent.  I have constant gas that I can't relieve, diarrhea that comes as soon as the pain hits, but no diagnosis.  The GI doc I'm seeing doesn't believe it could be caused by the pancreas divisum because the normal levels of amylase and lipase.  

My question is this:  with a divisum, can only one of these ducts be having trouble and therefore causing me pain and illness without affecting my blood work?  If one of the ducts is working fine could that be creating a seemingly normal evaluation, but the other duct (too small maybe) be blocked or backed up and causing all this?  The GI doc has reviewed my CT and does infact see the divisum so we know it's there, but she's not sure if she wants to go further with testing.  I've had the CT, ultrasound, endoscopy without a diagnosis other than the divisum.  Sorry to go on so long, but I feel like I'm gettiing sicker and don't know where to turn.

[Kevin Pho, MD]

Most cases of a divisum shouldn't cause refractory and continual pain like this.  And with a normal amylase and lipase level, it is unlikely that pancreatitis is the caue as well.

That said, if you want to further investigate the pancreas, the tests of choice would either be an MRI, MRCP or endoscopic ultrasound.  If those are normal, I would look at other organs that can potentially cause the pain.

To further evaluate the nausea and diarrhea, both an upper and lower endoscopy should be considered.

These options can be discussed with your GI physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd