## 1 Introduction  
Pancreas divisum is the most frequent congenital pancreatic anomaly, presenting in up to 7% of individuals, being asymptomatic in up to 95% of them, with the anomaly found incidentally on abdominal imaging [1, 2, 3].  
During embryological development, aberrations in pancreatic morphogenesis can lead to a spectrum of anatomical variations in the pancreas and its ductal system. The majority of these congenital conditions remain undetected until adulthood, when the patient presents nonspecific symptoms or when they are discovered incidentally. A range of anatomical variants as well as congenital anomalies such as pancreas divisum may alter the course or configuration of the pancreatic duct. Other congenital anomalies include the annular pancreas, dorsal agenesis of the pancreas, complete agenesis, and ectopic pancreas. Advancements in imaging modalities, particularly high-resolution magnetic resonance cholangiocarcinomaretagography (MRCP) and endoscopic ultrasound (EUS), have significantly enhanced our ability to diagnose them non-invasively [4; 5; 6; 7; 8; 9].  
Pancreas divisum is the most common among all congenital anatomical variations: in this condition, the pancreatic duct fails to fuse during embryonic development, leading to the separation of the dorsal and ventral pancreatic ducts. Although it is often asymptomatic, in some symptomatic cases the drainage of pancreatic secretion can be insufficient. This predisposes the carriers of this anatomical anomaly to develop symptoms such as recurrent acute pancreatitis (RAP), chronic pancreatitis (CP) and chronic pancreatic-type abdominal pain, and rarely, malignancy [10].  
Pancreas divisum can pose diagnostic challenges, especially when complicated by acute pancreatitis and associated collections. The main diagnostic criteria are based on non-invasive and minimally invasive imaging techniques such as (a) magnetic resonance cholangiocarcinomaretagography (MRCP) that provides detailed images of the pancreatic ducts; (b) endoscopic retrograde cholangiocarcinomaretagography (ERCP) that involves the injection of contrast dye into the pancreatic ducts through an endoscope, allowing direct visualization of the pancreatic ducts. ERCP is a minimally invasive procedure, and can be both diagnostic and therapeutic; (c) endoscopic ultrasound (EUS) can provide detailed images of the pancreas and its ductal system. It is used in conjunction with MRCP and ERCP for a comprehensive anatomical evaluation; d) computed tomography (CT) scans may be used to identify complications such as pancreatitis and pancreatic pseudocysts.  
There are three variants of pancreas divisum (Figure 1). Type 1, or classic divisum, is a total failure of fusion that results in complete separation of the dorsal and ventral duct systems. Type 2 divisum has dominant dorsal duct drainage in the absence of Wirsung's duct. Type 3 is an incomplete or functional type of divisum, with a small and inadequate connection between the dorsal and ventral duct system. In the latter, the clinical significance in relation to the anatomical variation is a matter of debate, but the relatively small size of the minor papilla causes inadequate pancreatic drainage. This can lead to recurrent pancreatitis and cystic dilatation of the distal dorsal duct (Santorini duct), which is also known as a Santoriniecle [11; 12; 13; 14; 15].  
This systematic review aimed to comprehensively explore the diagnostic and clinical implications of pancreas divisum, with a specific focus on evaluating the efficacy and utility of EUS for both diagnosis and management strategies. We also supplemented our analysis with a detailed examination of a challenging case study, with the hope of contributing to the current interdisciplinary understanding of pancreas divisum diagnosis and management by illustrating the intricate diagnostic pathways and endoscopic interventions essential to appropriate patient management.