Pancreas Divisum / MRCP / Stints

[Guest guest]

Hi,

I've posted several msgs on this group about my mother and her long,

horrible bout with severe acute pancreatitis. As I had stated, the

docs thought she had pancreas divisum. They determined this when

they did an ERCP early on in her bout. After that her condition

became quite bad and she had months where she was in the hospital way

more than she was out. She developed a lot of fluid collections

(pseudocysts/phlegmon) that got infected. The docs tried to drain

them, but ultimately had to do surgery to remove them and just a

little bit of her pancreas that was damaged. That was about 12 weeks

ago.

At this point she is doing a lot better. She is able to walk around

now and even drive some places. Although, she still cannot eat solid

food and drinks Ensures to give her enough calories a day.

The docs have been waiting for her condition to stabilize before

going further to identify what caused the attack. They thought that

she has pancreas divisum, but weren't 100% sure because her pancreas

was so inflamed when they did the test they said it made an exact

diagnosis difficult. So, now the docs want to go in an do another

test to verify their original diagnosis.

So, here are my main points/questions:

1) My mom really doesn't want to have another ERCP because of fear

that it would cause her to have another attack. The docs told her

that an MRCP could be done. They say it won't cause pancreatitis and

is good to diagnose pancreas divisum. Is this true? Also, could an

MRCP miss something that an ERCP wouldn't (i.e. cysts, etc.)?

2) If they do determine that she has pancreas divisum, the docs are

saying to us that the usual course of action is to put in a stint. I

have seen people talk about 'stints' all over the place, and it

appears that they're not always successful. Any thoughts on how

successful these stints could be?

3) Does anyone know of any pancreatic experts in the metro Atlanta

(GA) area that specialize in the course my mother is on?

Thanks for any info!

Tim

[Guest guest]

Tim,

An ERCP always has the risk of causing another case of acute

pancreatitis, though it is considered the gold standard for diagnosing

pancreas divisum. MRCPs are starting to challenge that, though I'm not

sure of their exact percentage of success in diagnosing it over an ERCP,

since they didn't have them when I was diagnosed with have a pancreas

divisum and I haven't done any specific research to find out. Hopefully

someone else in this group will have more of an idea of which is the

best way to go. If it was me, I'd have the MRCP done first, and if it

was negative or inconclusive, then, and only then, would I have the

ERCP. About 1/2 of all my ERCPs resulted in an attack of acute

pancreatitis and I am not willing to have anymore ERCPs since I have

already been diagnosed with the divisum.. The MRCP is less invasive.

Sometimes stints are highly successful and sometimes they aren't. It

seems to be a highly individual response. In my case, my ducts were so

small that they couldn't even get a stint in me and I ended up having

major surgery to try and correct the divisum. It wasn't fully successful

as they believe I was already chronic at that point and my attacks came

back after about 5 years. I think the surgery I had was called a

sphicteroplasty, but I'm not positive. What they did was unblock the one

duct that had been blocked since birth and then they widened both ducts.

My main problem is that my ducts are too small and two close together,

so that when one duct blocked and swelled, it cut off the other duct too

and all those destructive enzymes stayed in the pancreas and digested

the pancreas instead of my food. It would then cause an acute case of

pancreatitis. It created a horrible vicious cycle that has evidently

been going on since I was born. My pancreas is so damaged at this point

that I am diabetic and in End-Stage Chronic Pancreatitis.

Hopefully Poncho (the GA state rep), or someone else in GA, can give you

a recommendation on a specialist in GA as I am in CA and am afraid I

can't help you on that score. I would also check out the doctor database

on this yahoo groups website (where you joined the group) and see if

there is anyone listed in the GA area as well.

I hope my information has been of some help to you.

Kimber

--

Kimber

Vallejo, CA

hominid2@...

Note: All advice given is personal opinion, not equal to that of a licensed

physician or health care professional.