Uncommon Anatomy, Unrelenting Symptoms: Recurrent Acute-On-Chronic Pancreatitis In Pancreas Divisum: A Case Report

Background: Pancreas divisum is a common congenital pancreatic duct variant present in 4-22% of the population. While most individuals remain asymptomatic, impaired drainage through the minor papilla can lead to recurrent acute pancreatitis and, less often, chronic pancreatitis. Case Presentation: A 63-year-old Caucasian woman presented with acute epigastric pain radiating to the back, accompanied by nausea and vomiting. She had a two-year history of recurrent acute pancreatitis, with three hospital admissions over the preceding year. Serum lipase was markedly elevated (3359 U/L), and imaging demonstrated complete pancreas divisum with chronic changes in the pancreatic head. Common etiologies, including gallstones, hypertriglyceridemia, alcohol use, and autoimmune or genetic causes, were excluded. Following conservative management and subsequent endoscopic minor papilla sphincterotomy with dorsal duct stenting, her symptoms resolved and she remained asymptomatic during follow-up. Conclusion: This case highlights the clinical relevance of complete pancreas divisum as an overlooked cause of recurrent pancreatitis. Endoscopic minor papilla sphincterotomy and dorsal duct stenting offer effective, minimally invasive management for appropriately selected patients.