WOFAPS 2025 8th World Congress of Pediatric Surgery

Santiago Correa, Edgar Salamanca

Fundacion Cardioinfantil

Pancreas divisum is the most common congenital pancreatic malformation; however, its clinical significance remains uncertain. Most patients are asymptomatic, but some may develop clinical manifestations such as recurrent pancreatitis.

We present the case of an eight-month-old girl who was admitted to our institution with bilateral inguinal hernia. One week prior, she experienced diarrhea managed as amebic dysentery. During laparoscopic hernia repair, hematic ascites was observed, with omentum covering the transverse colon without perforation, but with mesenteric edema. These findings were linked to her recent history of dysentery. The ascites recurred, presenting with hematic features, poor oral intake, and abdominal pain.

A laparotomy revealed a small perforation in the transverse colon mesentery and in the head of the pancreas, with elevated amylase levels in the peritoneal fluid. Pancreas divisum was suspected, associated with pancreatic fistulae. An endoscopic papillotomy was attempted but was unsuccessful; consequently, a roux-en-y pancreatojejunostomy was performed to cover the fistula. Postoperatively, the patient’s symptoms improved, including oral intake and nutritional status. At two-year follow-up, she had no recurrence of ascites, abdominal pain, or vomiting, and maintained adequate nutritional status.

Pancreatic fistula due to pancreas divisum is a rare manifestation of this condition. Endoscopic management can be attempted; however, given the young age and potential need for multiple stent placements, roux-en-y pancreatojejunostomy may offer a more definitive solution.