A New Embryological Theory of the Pancreatic Duct System

Kamisawa, Terumi; Takuma, Kensuke; Egawa, Naoto; Takada, Koji; Sasaki, Tsuneo

doi:10.1159/000286906

Cited by 14 publications

(8 citation statements)

References 15 publications

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“…The ductal system of the ventral bud (duct of Wirsung) and the dorsal bud (duct of Santorini) fuse together to form the main pancreatic duct of Wirsung that opens at the major papilla along with the common bile duct. The accessory duct of Santorini often persists with varying patency and length, draining from the main duct to the minor papilla[13, 14] [Figure 1]. The etiology for PD is the failure of fusion of the two ductal systems to a varying degree leading to three known variants/subtypes.…”

Section: Epidemiology Embryogenesis Subtypesmentioning

confidence: 99%

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Identification and management of pancreas divisum

Gutta

Fogel

Sherman

2019

Expert Review of Gastroenterology & Hepatology

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Pancreas divisum, the most common congenital malformation of the pancreas, occurs due to a failure of fusion of the ductal systems of the dorsal and ventral pancreatic buds in the seventh week of intra-uterine life. This leads to a dominant dorsal pancreatic duct draining though the minor papilla and a small ventral pancreatic duct draining through the major papilla. The prevalence in western populations is about 10% and more than 95% of these patients are without pancreatic symptoms, with the anomaly found incidentally on abdominal imaging for an unrelated indication. The etiological role and clinical significance of pancreas divisum in relation to pancreatic disease has not yet been clearly defined, but may predispose to pancreatic disease in co-existence with other factors. Secretin-enhanced Magnetic Resonance Cholangiopancreatography is the non-invasive imaging modality of choice to identify pancreas divisum. Patients may be offered minor papilla therapy when they present with recurrent acute pancreatitis, severe acute pancreatitis and can be considered for therapy in the setting of chronic pancreatitis and chronic abdominal pain of pancreatic origin. Minor papilla endotherapy (sphincterotomy and/or stenting) via Endoscopic Retrograde Cholangiopancreatography and minor papilla surgical therapy have comparable outcomes with endotherapy typically considered first-line due to a favorable adverse event profile. The response to therapy is variable with maximal benefit seen in patients with recurrent acute pancreatitis and least with chronic pancreatic-type abdominal pain. Data supporting either therapy are of low quality as they are predominantly retrospective with a sub-optimal follow up period. Surgical options including a pancreatojejunostomy (Puestow or Frey procedure) or a total pancreatectomy with auto-islet cell transplantation may be considered in a subset of patients.

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Section: Epidemiology Embryogenesis Subtypesmentioning

confidence: 99%

“…(7.8% vs 3.5%)[30]. There have been reports of partial agenesis of the dorsal pancreas with PD with some debate as to whether the agenesis led to the PD or a consequence[14, 31].…”

Section: Associated Pancreatic-biliary Anomaliesmentioning

confidence: 99%

Identification and management of pancreas divisum

Gutta

Fogel

Sherman

2019

Expert Review of Gastroenterology & Hepatology

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“…The embryological mechanism of PBM is unclear; however, there are strong arguments for an abnormal embryology of the ventral pancreas until embryonic week four [2, 3]. In contrast, it is conceivable that the embryological mechanism of PD occurs by an abnormal fusion of the ventral and dorsal pancreatic ducts because the ventral pancreas fuses with the dorsal pancreas at embryonic weeks 6–7 [4]. That is, PBM and PD are congenital anomalies that develop in the embryo at an early stage, and they may be the result of bile and pancreatic duct misarrangement.…”

Section: Discussionmentioning

confidence: 99%

Embryological etiology of pancreaticobiliary system predicted from pancreaticobiliary maljunction with incomplete pancreatic divisum: a case report

Sanada¹,

Sakuma²,

Sata³

2018

BMC Surg

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BackgroundThe genesis of the “complex type” classification of pancreaticobiliary maljunction (PBM) is unclear, and the pancreaticobiliary anatomy is also varied according to each case. We encountered a patient with PBM and incomplete pancreatic divisum (PD). We herein discussed about the embryological etiology of pancreaticobiliary system predicted from PBM with incomplete PD.Case presentationA 67-year-old man was found to have a dilatation of the common bile duct (CBD) during a medical examination at 62 years of age. The dilatation of the CBD subsequently progressed, and he was admitted to our hospital for surgical treatment. Magnetic resonance cholangiopancreatography revealed a dilatation from the common hepatic duct to the middle bile duct with PBM. Endoscopic retrograde cholangiopancreatography from the papilla of Vater revealed the pancreatic main duct via the pancreatic branch duct, and PBM with dilatation of the CBD and incomplete PD were revealed. We performed an extrahepatic bile duct resection and hepaticojejunostomy because of high risk of malignant transformation. Taping and transection of the bile duct without dilatation on the pancreatic side were performed, and thereafter, two orifices of the common channel and ventral pancreatic duct were ligated. The level of amylase in the bile was 7217 IU/L, and a histological examination of the CBD showed an inflammatory change of CBD, not a malignant transformation.ConclusionIt is somewhat easy to identify the pancreatobiliary anatomy when the cause of embryology of both PBM and PD is thought to be an abnormal embryology of the ventral pancreas.

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“…It has two lobes, right and left. The left lobe usually regresses, and only the right lobe with its ductal system remains [ 4 ]. The two pancreatic primordia meet on the 37th day with a displacement of the ventral primordium dorsally and to the right around the duodenal axis following the duodenal movements (described later), so that the common bile duct is found anterior to the dorsal pancreatic duct.…”

Section: Reviewmentioning

confidence: 99%

The Story Retold: The Kocher Manoeuvre

Livani¹,

Angelis²,

Skandalakis³

et al. 2022

Cureus

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The Kocher manoeuvre is used for mobilization of the duodenum and head of the pancreas and bears the name of Theodor Kocher, who published it in 1903. We describe the embryology of the duodenum and pancreas, relating it to surgical anatomy applied during the procedure. Finally, we present the key points of the procedure, providing more insights into the anatomical structures that are mainly involved.

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A New Embryological Theory of the Pancreatic Duct System

Cited by 14 publications

References 15 publications

Identification and management of pancreas divisum

Identification and management of pancreas divisum

Embryological etiology of pancreaticobiliary system predicted from pancreaticobiliary maljunction with incomplete pancreatic divisum: a case report

The Story Retold: The Kocher Manoeuvre

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