Pancreatic divisum is a congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts. Most individuals with pancreas divisum remain without symptoms or complications. A minority of people with pancreatic divisum may develop episodes of abdominal pain, nausea or vomiting due to acute or chronic pancreatitis. The presence of pancreas divisum is usually identified with cross sectional diagnostic imaging, such as MRI or computed tomography (CT) imaging. In some cases, endoscopic retrograde cholangiopancreatography (ERCP) is performed, revealing the diagnosis of pancreas divisum. If no symptoms or complications are present, then treatment is not necessary. However, if there is recurrent pancreatitis, then a sphincterotomy of the minor papilla may be indicated. Causes
The human embryo begins life with two ducts in the pancreas, the ventral duct and the dorsal duct. Normally, the two ducts will fuse together to form one main pancreatic duct; this occurs in more than 90% of embryos. In approximately 10% of embryos the ventral and dorsal ducts fail to fuse together, resulting in pancreas divisum. In utero, the majority of the pancreas is drained by the dorsal duct which opens up into the minor duodenal papilla. The ventral duct drains the minority of the pancreas and opens into the major duodenal papilla. In adults however, this situation is reversed whereby 70% of the pancreas is drained by the ventral duct.
Gastric atresia is a congenital defect with complete occlusion of the pyloric outlet of the stomach. Cause
Gastric atresia is a birth defect. It can be genetic, inherited in an autosomal recessive manner, and associated with conditions like Down syndrome and junctional epidermolysis bullosa (medicine). In about 60% of cases, the outlet of the stomach is covered by a membrane. In around 35% of cases, solid tissue blocks the outlet. In the remaining cases (less than 10%), there is a complete separation of the stomach and the small intestine. Diagnosis
Polyhydramnios is often seen during pregnancy, and prenatal diagnosis is common. Infants with gastric atresia will exhibit forceful vomiting upon the first feeding. Imaging is required for diagnosis. Treatment
Treatment is surgical and involves removing or bypassing the obstruction. Epidemiology
It is seen in approximately 1 in 100,000 live births. == References ==