Pancreas divisum is a birth defect in the anatomy of the pancreas where the normal drainage of the pancreas is altered so that most of the pancreatic drainage has to pass through the smaller duct and sphincter of the pancreas. This may cause problems in draining all of the pancreatic juices which may back up and cause pancreatitis and/or abdominal pain because of elevated pressures in the duct. Improvement in drainage of this smaller duct can be done with ERCP.
However, when scarring occurs around the small duct in the substance of the pancreas, endoscopic treatment can't open up this scar tissue in the pancreatic substance and an operation is required to improve the drainage of the pancreas. If the pancreatic duct becomes dilated, a Puestow procedure can be done. If the pancreatic duct does not become dilated, then this problem can be treated successfully with the Whipple procedure.