Pancreatic Duct System With 2 Points of Embryological Fusion Between the Ventral and Dorsal Pancreatic Ducts

Kuruma, Sawako; Kamisawa, Terumi; Hara, Seiichi; Tabata, Taku; Chiba, Kazuro; Saito, Itaru; Egashira, Hideto; Kuwata, Go; Fujiwara, Takashi; Koizumi, Koichi; Fujiwara, Junko; Arakawa, Takeo; Momma, Kumiko

doi:10.1097/mpa.0b013e318272508b

Cited by 1 publication

(1 citation statement)

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“…Moreover, in interventional procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), correct knowledge of the normal anatomy and the relative variations is necessary in order to plan adequate treatment and prevent iatrogenic injuries. Anatomical variations in pancreatic surgery play a role in anastomosis failure; in cases of ductal anomalies, drainage can be impaired in some areas, causing obstructive pancreatitis and altering the function of the anastomosis (Kuruma et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Pancreas divisum inversus

2019

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Pancreatic duct variations are usually diagnosed incidentally, in particular when using magnetic resonance cholangiopancreatography (MRCP), the most accurate imaging modality for depicting the pancreatic ductal system. However, the frequency and the embryologic development of pancreatic variants have not been well investigated. The purpose of this prospective study was to investigate the frequency of pancreatic ductal variants, providing potential explanations of their embryologic basis. The pancreatic ductal anatomies of 202 patients with mean ± SD age of 54 ± 27 years, 56% females, who underwent MRCP for different indications between April 2018 and March 2019 were prospectively collected. Normal pancreatic ductal variants were identified in 196 cases (97%), and variants of pancreas divisum in 6 cases (3%). In the type C variant of the normal pancreatic anatomy, found in 3% of cases, the dorsal duct was joined to the ventral duct while the accessory duct did not communicate with the dorsal duct. Unlike the classical type C variant, in our cases, the accessory pancreatic duct was very long (mean ± SD of 58 ± 8.5 mm) and originated in the lower portion of the pancreatic head, caudally to the duct of Wirsung. This was a new subtype of the type C variant or a new variant which could be called "pancreas divisum inversus"; the accessory pancreatic duct could be called the Isolated duct of Santorini. Reporting this new variant 2 could increase the knowledge regarding pancreatic anatomy to avoid misdiagnosis and to help in better understanding pancreatic diseases and their relative treatment.

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Section: Discussionmentioning

confidence: 99%