Congenital Variants and Anomalies of the Pancreas and Pancreatic Duct: Imaging by Magnetic Resonance Cholangiopancreaticography and Multidetector Computed Tomography (original) (raw)

Anatomical Description of the Duct System of the Pancreas: A Cadaveric and Magnetic Resonance Cholangiopancreatography Study

Journal of Medical Academics

Variations in the development and fusion of the dorsal and ventral pancreatic ducts lead to atypical arrangements in the anatomy of the main and accessory pancreatic ducts. 4 While some variants may produce clinical symptoms like recurrent abdominal pain, nausea, and vomiting, anatomic variations in the main pancreatic duct (MPD) are missed in asymptomatic patients and are not discovered until adulthood. 5 These anomalies are important to be identified because these may be surgically amenable causes of recurrent pancreatitis or gastric outlet obstruction. 2 Itoh et al. IntroductIon The pancreas, a retroperitoneal and compound racemose gland, is structurally similar to the salivary glands but softer, and less compact. 1 Composed of two types of closely associated glandular tissue, the principal mass is exocrine pancreas in which aggregates of endocrine cells called the Islet of the pancreas are embedded. The development of the human pancreas begins at 5th week of gestation with the emergence of ventral and dorsal pancreatic buds as projections from the primitive foregut. By 7th gestational week, with growth of the duodenum, the ventral bud on right side rotates to pass behind the duodenum and fuses with the dorsal bud on left side. The ventral bud forms the posterior part of the head and the uncinate process, while the anterior head, body, and tail of the pancreas are formed by the dorsal bud. The ductal systems anastomose in varying patterns to form the adult duct system of pancreas. 1-3 Anatomy of the duct system of pancreas is important because of its surgical significance making it a fascinating topic for anatomists since as clinically relevant variations can be studied by them. The ventral pancreatic duct and distal part of the dorsal pancreatic duct anastomoses and form the major pancreatic duct of Wirsung, which opens in the ampulla of Vater. The duct of Santorini is formed by proximal part of the dorsal pancreatic duct and opens into the minor papilla. In case of failure of development of the duodenal end of the accessory duct, lobar ducts drain via small channel(s) into the main duct. 4

Congenital Anomalies and Normal Variants of the Pancreaticobiliary Tract and the Pancreas in Adults: Part 1, Biliary Tract

American Journal of Roentgenology, 2006

The purpose of this article is to highlight the imaging features of congenital anomalies and normal variants of the biliary tract with contemporary imaging techniques such as MR cholangiopancreatography (MRCP), MRI, and helical CT. CONCLUSION. Recognizing findings of congenital anomalies and normal variants of the biliary tract at MRCP, MRI, and helical CT, and knowledge of the clinical significance of each entity, are important for establishing a correct diagnosis and in guiding appropriate clinical management.

Anatomical Patterns of the Pancreatic Ductal System – A Cadaveric and Magnetic Resonance Cholangiopancreatography Study

Journal of Morphological Sciences

Introduction Morphological variants of the pancreatobiliary system can predispose to chronic pancreatitis. The goal of the present study is to assess the prevalence of pancreatic duct patterns in the Indian population, both by cadaveric dissection and by magnetic resonance cholangiopancreatography (MRCP). Materials and Methods A total of 15 adult pancreas specimens of unknown age and gender, and 5 fetal pancreas specimens of different gestational ages with the intact second part of duodenum, were dissected by the piecemeal method. For clinical relevance, MRCP images of 103 clinically-diagnosed chronic pancreatitis patients irrespective of their etiology were obtained retrospectively from the existing database and studied. The anatomical patterns were classified as five different types based on the course of the main pancreatic duct and the accessory pancreatic duct and their openings into the duodenal wall, including variants like pancreas divisum and ansa pancreatica. Results In th...

Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients

Radiology and Oncology, 2016

Background The study was conducted to evaluate the frequencies of the anatomic variations and the gender distributions of these variations of the pancreatic duct and their relevance with the Cambridge classification system as morphological sign of chronic pancreatitis using magnetic resonance cholangiopancreatography (MRCP). Patients and methods We retrospectively reviewed 1312 consecutive patients who referred to our department for MRCP between January 2013 and August 2015. We excluded 154 patients from the study because of less than optimal results due to imaging limitations or a history of surgery on pancreas. Finally a total of 1158 patients were included in the study. Results Among the 1158 patients included in the study, 54 (4.6%) patients showed pancreas divisum, 13 patients (1.2%) were defined as ansa pancreatica. When we evaluated the course of the pancreatic duct, we found the prevalence 62.5% for descending, 30% for sigmoid, 5.5% for vertical and 2% for loop. The most com...

Cadaveric Study of the Anatomical Variations of the Accessory Pancreatic Duct

Journal of Bangladesh Society of Physiologist, 2015

Background: The accessory pancreatic duct enters the duodenum at the minor duodenal papilla, developmentally draining the dorsal pancreatic bud; however, it is smaller and less constant than the main pancreatic duct and undergoes varying degrees of atrophy at the duodenal end. Objective: The objective of this study was to see the variations in course, opening and communication pattern of the accessory pancreatic duct in different age-groups in a Bangladeshi population. Methods: This crosssectional, descriptive study was done was done in the Department of Anatomy, Dhaka Medical College, Dhaka, from August 2005 to December 2006, based on collection and dissection of 75 postmortem male human pancreas. The collected samples were divided into seven age groups: 10-19 years, 20-29 years,30-39 years, 40-49 years, 50-59 years),60-69 years and(eˆ70 years. However, 65 samples were taken for final observation. Results: The accessory pancreatic duct was found in 27.69% specimens. Straight course...

Intrahepatic biliary duct branching patterns, cystic duct anomalies, and pancreas divisum in a tertiary referral center: A magnetic resonance cholangiopancreaticographic study

Indian Journal of Gastroenterology, 2016

Background Knowledge about anatomic variations in intrahepatic biliary ducts (IHBD) is relevant for performing biliary drainage and for avoiding bile duct injury during cholecystectomy and liver resections. Low insertion of cystic duct (LICD) is a common anatomic variant. Pancreas divisum is the commonest congenital anomaly of pancreas; it has been causally linked with recurrent acute pancreatitis (RAP). Methods Magnetic resonance cholangiopancreaticography (MRCP) images of 500 consecutive patients were reviewed for anatomic variants of IHBD, cystic duct, and pancreatic duct. Results Anatomy of IHBD could be evaluated in 458 MRCP's, of these 301 (65.72 %) had 'typical' anatomy. The variant in 157 persons included 'triple confluence' in 56 (12.23 %), 'right posterior segmental duct (RPSD) draining to left hepatic duct (LHD)' in 64 (14 %), 'RPSD to common hepatic duct (CHD)' in 20 (4.4 %), 'RPSD to cystic duct' in 2 (0.4 %), 'accessory duct to CHD' in 3 (0.7 %), 'accessory duct to right hepatic duct (RHD)' in 1 (0.2 %), 'segment 2 and 3 separately to CHD' in 1 (0.2 %), and complex variants in 10 (2.2 %). Cystic duct could be evaluated in 338 patients; of these, 15 (4.4 %) had LICD. Patients with RAP had pancreas divisum more often than those without any pancreatic disease, (−/−,10 % and −/−, 0.8 %; p = 0.004). Conclusions Nearly one third of MRCPs showed atypical IHBD pattern with RPSD draining to LHD being the commonest. LICD was the most common cystic duct variant. Pancreas divisum was more frequent in patients with RAP than in persons without pancreatic disease.

Unusual variants of the tributaries of the main pancreatic duct revealed by postmortem and endoscopic pancreatography

Annals of Anatomy - Anatomischer Anzeiger, 1996

Analysis of 97 human postmortem pancreatograms and 103 endoscopic pancreatograms revealed a total of 3 cases (1.5070) with isolated variants in the branches of the main pancreatic duct. In the first one, tortuous branches were present in the upper head-body region. The second case involved joint tributaries bridging over an unstenosed segment of the main pancreatic duct. In the third case, we found three branches from the uncinate process running down to the main duct. In all of these cases no pathological substrate was found, and they should be considered as anatomical variants observed during interpretation of a radiogram.

A rare congenital anomaly of the pancreas: a cadaveric case report

2013

Context The pancreas is formed by ventral and dorsal pancreatic buds which arise from the endodermal lining of the gut. When the duodenum rotates to the right, the ventral pancreatic bud migrates dorsally and finally come and lie below the dorsal pancreatic bud. The developmental errors in the rotation of these components lead to annular pancreas. Case report We report a rare type of the incomplete annular pancreas around the contents of right free margin of lesser omentum. There was an extra pancreatic mass situated horizontally immediately above the superior border of the pancreas, situated behind the lesser omentum. The right end of this mass extended into the epiploic foramen and incompletely encircled the portal vein, bile duct and hepatic artery proper from behind. The left end of the extra pancreatic mass was extended towards the lesser curvature of the stomach. Further, this mass completely surrounded the origin of three branches of the celiac trunk. Its right end was found to be continuous with the head of the pancreas, close to the pylorus. Histology of the extra pancreatic mass revealed the presence of normal pancreatic tissue. Conclusion preoperative diagnosis of this rare anomaly is of clinical importance during surgeries involving the contents of right free margin of lesser omentum and epiploic foramen.