Introduction: Current management of pancreatitis associated with pancreas divisum involves therapeutic ERCP as the initial treatment modality. In those who do not respond to endoscopic therapy, surgery remains an important intervention. We present our experience of 21 patients with pancreatitis and pancreas divisum. Methods and Procedures: A retrospective review of 21 charts from one surgical service was performed with the inclusion criteria being only the diagnosis of pancreatitis and pancreas divisum from 1997 to the present. Data collected consisted of demographics; number, frequency, and types of endoscopic intervention; surgical intervention; and response to therapy. Results: There were 6 males and 15 females. Ages ranged from 16-89 years (mean 47.8 years). 16 Patients (76.2%) were primarily referred to our service and 5 patients (23.8%) were referred for surgery by gastroenterologists. 17 patients (81.0%) were successfully treated with various techniques. 3 patients (14.3%) have failed multiple treatment strategies. 1 patient (4.8%) who had a pancreaticoduodenectomy was lost to follow up. All 21 patients were initially managed by ERCP. 11 patients (53.4%) were managed solely by therapeutic ERCP. These patients underwent a mean of 3.4 (range 1-7) ERCP with sphincterotomy and stenting. This cohort remains asymptomatic for a mean of 40.0 months (range 2-98). Surgical management was used for 10 patients (47.6%) in whom ERCP was not possible (3), had little or no resolution of symptoms from ERCP (4) or no longer desired further endoscopic treatments (4). 6 patients (28.6%) underwent open transduodenal sphincteroplasty. 3 patients are asymptomatic at a followup of 9.3 months (range 5-13). 1 patient has had recurrent symptoms. 2 patients were further managed by pancreaticoduodenectomy; both with dramatic improvement. 4 patients (19.0%) had pancreaticoduodenectomy as a second intervention; 2 patients have reduced symptoms. Conclusion: Endoscopic intervention in pancreas divisum is the appropriate initial tool as both diagnostic and therapeutic measures. Operative management may be used for those patients who have multiple recurrent stenoses, patients in whom endoscopy is not technically feasible or no longer desire endoscopy. Open sphincteroplasty is the most suitable initial surgical intervention. Pancreaticoduodenectomy may be applicable in select refractory cases.