Variations and Anomalies of the Papilla of Vater, the Pancreas and the Biliary Duct System

J, Phillip; Koch, Horst; Claßen, Martin

doi:10.1055/s-0028-1098600

Cited by 37 publications

(9 citation statements)

References 4 publications

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“…This compares with an incidence of 1-3-6 % (overall 3 7 %) for this anomaly in previous reports of pancreatic duct abnormalities found at ERCP (Phillip et al, 1974;R6sch et al, 1976;Gregg, 1977;Kruse, 1977;Thompson et al, 1978). Cannulation of the accessory ampulla is technically extremely difficult and it was possible to achieve this on only one occasion.…”

Section: Discussionsupporting

confidence: 50%

Clinical relevance of an unfused pancreatic duct system.

Mitchell¹,

Lintott²,

Ruddell³

et al. 1979

Gut

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SUMMARY In man, the main pancreatic duct is normally derived from ventral and dorsal embryological buds of the pancreas. In a minority of people, failure of fusion of the two buds results in separate drainage of the dorsal and ventral pancreas, so that the accessory duct provides the main drainage for the gland. Patients with this anomaly demonstrated at endoscopic retrograde pancreatography (ERP) have been investigated to assess whether non-fusion of the main pancreatic duct predisposes to the development of pancreatitis. A failure of fusion of the pancreatic ducts was seen in 21 out of 449 (4-7 %) successful pancreatograms; four of these 21 patients had definite clinical evidence of pancreatitis and two patients had possible pancreatic disease, but in the remainder the anomaly was not considered to be clinically relevant. An abnormal pancreatogram suggesting pancreatitis was present in 116 out of the 428 patients (27.1 %) with a normally fused duct system. The anomaly was found as frequently in the whole series as it was seen in patients with pancreatitis. These findings suggest that embryological failure of pancreatic duct fusion does not predispose to the development of pancreatitis. However, the presence of this anomaly may lead to misinterpretation of ultrasonographic and CT scan findings.The pancreas is formed embryologically from distinct ventral and dorsal buds which arise from the duodenal diverticulum after rotation of the ventral bud and have fused by the seventh week of life (Meckel, 1812). Wirsung (1642) first demonstrated the main pancreatic duct in man and Santorini (1775) accurately described the duct system and demonstrated the accessory pancreatic duct.Normally, the main pancreatic duct is derived from both embryological parts of the pancreas; the dorsal pancreas provides the main duct in the tail and body of the gland with the ventral anlage providing the main duct in the head of the gland. The accessory duct (of Santorini) is the remaining portion of the duct in the dorsal pancreas which may drain through an accessory papilla more proximally in the duodenal loop.It is thus not surprising that anomalies of the pancreatic duct system occur and their frequency has been documented in large systematic necropsy studies by Baldwin

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Section: Discussionsupporting

confidence: 50%

Clinical relevance of an unfused pancreatic duct system.

Mitchell¹,

Lintott²,

Ruddell³

et al. 1979

Gut

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“…It is the confirmative tool for diagnosis and treatment of disorders of PD and bile duct, even though magnetic resonance cholangiopancreaticography has emerged as an alternative procedure 1-5. In addition, the images of PD and bile duct obtained by ERCP have been shown to agree with the pattern and anomaly of PD detected by surgery or autopsy 6,7…”

Section: Introductionsupporting

confidence: 57%

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

et al. 2006

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The aims of this study were to identify the morphological diversities and anatomical variations of pancreatic ductal system and to define the relationships between pancreatic ductal systems, pancreaticobiliary diseases, and procedure-related complications, including post-ERCP pancreatitis. This study included 582 patients in whom both pancreatic duct (PD) and common bile duct were clearly visible by ERCP. PD systems were categorized into four types according to the relationship between common bile duct and PD. In types A and B, Wirsung duct formed the main PD. In type C, Wirsung duct did not form the main PD. If PD system did not fall into any of these three types, it was categorized as type D. The distribution of types among pancreatic ducts examined was as follows: type A: 491 cases (84.4%), type B: 56 cases (9.6%), type C: 20 cases (3.4%), and type D: 15 cases (2.6%). The anomalous anatomic variations of PD systems were divided into migration, fusion, and duplication anomalies. PD anomalies were noted in 51 patients, of which 19 (3.3%) were fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum), and 32 (5.5%) were duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. However, post-ERCP hyperamylasemia was more frequently found in types C (41.7%), D (50%) and A (19.8%) than in type B (9.4%). In summary, whether Wirsung duct forms the main PD and the presence or absence of the opening of the Santorini duct are both important factors in determining the development of pancreatitis and hyperamylasemia after ERCP.

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“…Other morphological changes which have been demonstrated and which may produce difficulties in radiological interpretation are: (a) narrowed ducts not due to stricture; (b) space-occupying lesions due to superior mesenteric artery, splenic artery, aorte, vertebral osteophytes, sympathetic ganglion, and lymph nodes; (c) metastases in the pancreas -these must be distinguished from pri mary pancreatic carcinoma. Phillip et al (65) described also variations of the papilla of Vater, the pancreas and the biliary duct system. It is important to differentiate changes with aging, normal variations and anomalies from patho logical findings on pancreatogram.…”

Section: Validity O F the Morphological Criteriamentioning

confidence: 99%

Recent Advances in the Endoscopic Retrograde Cholangiopancreatography

Kasugai

1975

Digestion

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Endoscopic retrograde cholangiopancreatography can become a safe and easy procedure by means of sterilization of the instruments. Administration of antibiotics or chemotherapeutic agents, both systemically and mixed with the contrast material, and measurement and control of the injection pressure of the contrast medium using a manometer are employed to achieve as aseptic an operation as possible. For diagnosis of pancreatic cancer in its early stage, as well as diagnosis of minimal and moderate chronic pancreatitis, opacification should extend into not only the main pancreatic duct, but also branches of the pancreatic duct and fine pancreatic ducts. The procedure is one of the most reliable methods for the detection of diseases of pancreatic and biliary systems, especially for the diagnosis of space-occupying lesions such as malignant tumors, and chronic inflammatory changes of the pancreas, as well as differential diagnosis in jaundiced patients.

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Variations and Anomalies of the Papilla of Vater, the Pancreas and the Biliary Duct System

Cited by 37 publications

References 4 publications

Clinical relevance of an unfused pancreatic duct system.

Clinical relevance of an unfused pancreatic duct system.

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

Recent Advances in the Endoscopic Retrograde Cholangiopancreatography

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