Preoperative Investigation and Preparation for the Procedure

History: Recurrent episodes of epigastric pain, especially with radiation through to the mid back; pain starts sporadically, with bouts months apart, but may become frequent and even constant; attacks are usually mild, more common in young women; mean onset is at 34years but can occur in childhood, onset is uncommon after age 50years.

Clinical evaluation: May have tenderness over the pancreas.

Laboratory tests: Serum amylase and/or lipase.

Imaging: ERCP or MRCP to elucidate pancreatic ductal anatomy; ERCP must include opacification of the dominant dorsal duct via accessory papilla. Caution: acquired obstruction of the duct of Wirsung by tumor in the pancreatic head can mimic pancreas divisum.

Functional tests: Transabdominal ultrasonography, endoscopic ultrasonography, or MRCP with secretion stimulation - demonstrates abnormally delayed return of principal pancreatic duct to normal size after hyperstimulation of pancreatic secretion. Impaired emptying through stenotic accessory papilla results in persistent (15- to 30-min) duct dilation.

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