Reviewer's report 
 The course of traumatic pancreatitis in a patient with pancreas divisum: a case report Title: 
Authors: 
Dr Evangelia G Chryssou ( gellych@hotmail.com )
Panos Prassopoulos ( prassop@med.uoc.gr )
Prof John Mouzas ( mouzas@med.uoc.gr )
Thomas G Maris ( tmaris@med.uoc.gr )
Nicholas Gourtsoyiannis ( gournick@med.uoc.gr )
 1  25 Nov 2002 Version: Date: 
 Prof Jose Sahel Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Other (see below) Advice on publication: 
This paper reports on a case of pancreas divisum complicated by a cyst in the head of the pancreas, 
developped on the dorsal segment, and associated with a slight dilatation of the dorsal duct system. 
The peculiarity of the observation is that acute attacks of pancreatic pain were observed 4 months after a blent abdominal trauma. Several questions arise but answers are unclear or controversial. 
1/ Were the recurrent attacks of pancreatitis (8 episodes) secondary to the cyst or to pancreas 
divisum itself ? Since endoscopic cyst-duodenostomy was followed by both disappearance of the cyst and improvement of the patient's condition, the first hypothesis is likely to be right. 
2/ MRCP confirmed the diagnosis of pancreas divisum and showed a cyst in the head of the 
pancreas and a dilatation of the dorsal ducts. 2-1 : This technique of imaging is usually unable to show the communication between ducts and the cyst (exept when IV secretin is done). In the observation it can be said that there was a continuity, 
rather than a communication, between the cyst and the dorsal ducts. The only way to demonstrate a 
communication should be dorsal pancreatography but unfortunately, cannulation of the minor papilla 
was unsuccessful. 
2-2 : There is a discrepancy between the slight dilatation of the dorsal ducts, and the " atrophy " of 
the body and tail of the pancreas demonstrated by MRI. 
3/ Was the cystic lesion secondary to the abdominal trauma ? This is questionable, especially 
because of the small size of the cyst and its location in the head (and not in the body as usually 
reported) of the pancreas. The authors do not indicate whether an imaging work-up (echography, 
CT) was performed at the time of the blunt trauma. 
4/ Follow-up of the patient should be continued since he " is still unfrequently, complaining of mild 
upper abdominal pain ". If a relationship can be established between pain and pancreas divisum, or 
between pain and pancreatitis located on the dorsal duct system (was the patient alcoholic ?), then a 
treatment of the ductal abnormality should be tried by either endoscopic sphincterotomy of the minor 
papilla, or dorsal duct stenting or surgical sphincteroplasty of the minor papilla. 
Competing interests: 
None declared. 
Reviewer's report 
 The course of traumatic pancreatitis in a patient with pancreas divisum: a case report Title: 
Authors: 
Dr Evangelia G Chryssou ( gellych@hotmail.com )
Panos Prassopoulos ( prassop@med.uoc.gr )
Prof John Mouzas ( mouzas@med.uoc.gr )
Thomas G Maris ( tmaris@med.uoc.gr )
Nicholas Gourtsoyiannis ( gournick@med.uoc.gr )
 1  25 Nov 2002 Version: Date: 
 Prof Jose Sahel Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Other (see below) Advice on publication: 
This paper reports on a case of pancreas divisum complicated by a cyst in the head of the pancreas, 
developped on the dorsal segment, and associated with a slight dilatation of the dorsal duct system. 
The peculiarity of the observation is that acute attacks of pancreatic pain were observed 4 months after a blent abdominal trauma. Several questions arise but answers are unclear or controversial. 
1/ Were the recurrent attacks of pancreatitis (8 episodes) secondary to the cyst or to pancreas 
divisum itself ? Since endoscopic cyst-duodenostomy was followed by both disappearance of the cyst and improvement of the patient's condition, the first hypothesis is likely to be right. 
2/ MRCP confirmed the diagnosis of pancreas divisum and showed a cyst in the head of the 
pancreas and a dilatation of the dorsal ducts. 2-1 : This technique of imaging is usually unable to show the communication between ducts and the cyst (exept when IV secretin is done). In the observation it can be said that there was a continuity, 
rather than a communication, between the cyst and the dorsal ducts. The only way to demonstrate a 
communication should be dorsal pancreatography but unfortunately, cannulation of the minor papilla 
was unsuccessful. 
2-2 : There is a discrepancy between the slight dilatation of the dorsal ducts, and the " atrophy " of 
the body and tail of the pancreas demonstrated by MRI. 
3/ Was the cystic lesion secondary to the abdominal trauma ? This is questionable, especially 
because of the small size of the cyst and its location in the head (and not in the body as usually 
reported) of the pancreas. The authors do not indicate whether an imaging work-up (echography, 
CT) was performed at the time of the blunt trauma. 
4/ Follow-up of the patient should be continued since he " is still unfrequently, complaining of mild 
upper abdominal pain ". If a relationship can be established between pain and pancreas divisum, or 
between pain and pancreatitis located on the dorsal duct system (was the patient alcoholic ?), then a 
treatment of the ductal abnormality should be tried by either endoscopic sphincterotomy of the minor 
papilla, or dorsal duct stenting or surgical sphincteroplasty of the minor papilla. 
Competing interests: 
None declared. 
Please review this paper.
user
Reviewer's report 
 The course of traumatic pancreatitis in a patient with pancreas divisum: a case report Title: 
Authors: 
Dr Evangelia G Chryssou ( gellych@hotmail.com )
Panos Prassopoulos ( prassop@med.uoc.gr )
Prof John Mouzas ( mouzas@med.uoc.gr )
Thomas G Maris ( tmaris@med.uoc.gr )
Nicholas Gourtsoyiannis ( gournick@med.uoc.gr )
 1  25 Nov 2002 Version: Date: 
 Prof Jose Sahel Reviewer: 
 A paper whose findings are important to those with closely related research Level of interest: 
interests 
 Other (see below) Advice on publication: 
This paper reports on a case of pancreas divisum complicated by a cyst in the head of the pancreas, 
developped on the dorsal segment, and associated with a slight dilatation of the dorsal duct system. 
The peculiarity of the observation is that acute attacks of pancreatic pain were observed 4 months after a blent abdominal trauma. Several questions arise but answers are unclear or controversial. 
1/ Were the recurrent attacks of pancreatitis (8 episodes) secondary to the cyst or to pancreas 
divisum itself ? Since endoscopic cyst-duodenostomy was followed by both disappearance of the cyst and improvement of the patient's condition, the first hypothesis is likely to be right. 
2/ MRCP confirmed the diagnosis of pancreas divisum and showed a cyst in the head of the 
pancreas and a dilatation of the dorsal ducts. 2-1 : This technique of imaging is usually unable to show the communication between ducts and the cyst (exept when IV secretin is done). In the observation it can be said that there was a continuity, 
rather than a communication, between the cyst and the dorsal ducts. The only way to demonstrate a 
communication should be dorsal pancreatography but unfortunately, cannulation of the minor papilla 
was unsuccessful. 
2-2 : There is a discrepancy between the slight dilatation of the dorsal ducts, and the " atrophy " of 
the body and tail of the pancreas demonstrated by MRI. 
3/ Was the cystic lesion secondary to the abdominal trauma ? This is questionable, especially 
because of the small size of the cyst and its location in the head (and not in the body as usually 
reported) of the pancreas. The authors do not indicate whether an imaging work-up (echography, 
CT) was performed at the time of the blunt trauma. 
4/ Follow-up of the patient should be continued since he " is still unfrequently, complaining of mild 
upper abdominal pain ". If a relationship can be established between pain and pancreas divisum, or 
between pain and pancreatitis located on the dorsal duct system (was the patient alcoholic ?), then a 
treatment of the ductal abnormality should be tried by either endoscopic sphincterotomy of the minor 
papilla, or dorsal duct stenting or surgical sphincteroplasty of the minor papilla. 
Competing interests: 
None declared. 
assistant