The anatomy of the blood-vessels in the region of the pancreas

Abstract

SURGICAL PROFESSORIAL UNIT, ST. BARTHOLOMEW'S HOSPITALOPERATIONS on the pancreas are being undertaken with increasing frequency, and the vascular arrangements in and around the gland have now considerable surgical importance.The arteries have been exhaustively studied by many observers, and an accurate knowledge of their pattern has been gradually obtained. On the other hand, accounts of the venous drainage of the pancreas, and of the tributaries of the portal vein and their principal variations, are inadequate.The present study was undertaken to amplify the standard descriptions and if possible to provide a guide to surgeons interested in the surgery of the pancreas and the duodenum.The earliest accounts of the pancreatic arteries were lacking in detail; arcades between the pancreatic arteries arising from the coeliac axis and those from the superior mesenteric artery were not recog- Petren undertook a very full review of the literature in 1929. His account was illustrated by excellent drawings and, with its clear nomenclature, provided an accurate description of the vessels of the head of the pancreas, but he did not discuss the vasculature of the neck and body. Wharton (1932) described a branch of the superior mesenteric artery-the inferior pancreatic -which coursed along the lower border of the pancreas, and a contribution of three to five pancreatic branches from the splenic artery. He also identified anterior and posterior pancreaticoduodenal veins, a group of pancreatic tributaries of the splenic vein, and several other inconstant tributaries which joined the portal vein from the head of the gland. Kirk (1932) described a " supreme pancreatic artery " which appeared to supply the neck and body of the gland, and which took origin from the coeliac axis or from the splenic artery ; and also a middle pancreatic arterial arcade buried in the substance of the head of the gland. In his account of the veins, he drew attention to an inferior pancreatic vein originally described by Tonkoff (1903) and a vein draining the neck of the pancreas which he named the " vena colli pancreatis ".Pierson (1943) reviewed the arterial bloodsupply of the pancreas in 50 dissections, but dismissed the veins briefly as accompanying and superficial to the arteries.Descomps and de Lalaubie (1912), in a series of dissections of the mesenteric veins, made some valuable observations on the venous drainage of the pancreas and on the tributaries of the superior mesenteric, portal, and splenic veins ; they also described variations in the colic veins and illustrated the vena colli pancreatis, although it was not mentioned in their text. MATERIAL AND METHODSIn the present review, 50 specimens-27 dissections and 23 injection-corrosion preparationswere studied in detail, the material being obtained at autopsy. In most specimens the liver, bileducts, stomach, duodenum, pancreas, and spleen were removed in one piece by the pathologist, and the dissection was continued after partial fixation in Jore's and Kaiserling's fluids. In the remaining spec...

The arterial blood supply of the pancreas: a review III. The inferior pancreaticoduodenal artery

“…In summary, the IPD a. has been observed stemming: 1) directly from the superior mesenteric a. [3,8,9,13,14,18,22,23,25,27,28,29,31,36,38,42]. The incidence of this origin has been reported exclusively in the anatomical papers and is valued with very different percentages according to the investigators, ranging from 4.6 [9] to 100% of the cases [40]; Bertocchi and Bianco [6], however, did not encounter such an arising for the IPD a.…”

Venous Drainage from the Posterior Aspect of the Pancreatic Head and Duodenum

“…The veins of the retrovenous or prevenous pancreas (Birtwisle et al, 1983) and the pancreatic cervical vein (Falconer and Griffiths, 1950) were short and drained a small part of the parenchyme of the pancreatic head. The inferior isthmic vein (Mourad et aL, 1994) communicated with the splenic vein.…”

“…Venous tributaries exiting on the anterior aspect of the pancreatic head and duodenum frequently join and converge at the infero-medial portion of the region, resulting in the formation of the gastrocolic venous trunk (Falconer and Griffiths, 1950;Reichardt and Gameron, 1980;Birtwisle et al, 1983;Donatini, 1990;Mourad et aL, 1994). Such inferior convergence on the anterior aspect is clearly in contrast to the supero-medial convergence of the venous drainage route seen in Types C and D (total 71.1 %) on the posterior aspect.…”

“…Falconer and Griffiths (1950) reported that the PSPDv usually passed behind the common bile duct (CBD), but that, in the case of duplication, the upper PSPDv was located anterior to the CBD in contrast to the lower PSPDv which had a posterior course. Moreover, Reichardt and Cameron (1980) reported that the upper PSPDv is a separate entity, called the posterior superior vein, which they frequently observed.…”

Systematisation of the Arteries in the Splenic Hilus

“…The vessel is named arteria pancreatica magna seu suprema [Haller, 1756;Dolgo-Saburoff, 1927; most french anatomists], arteria pancreatica superior [Petren, 1929;Pierson, 1943;Falconner and Griffiths, 1950;Descomps, 1910;Testut, 1928;Kosinski, 1928], arteria pancreatica media superior et inferior [Rio Bran co da Silva, 1912], arteria isthmi [Theile, 1843;Bourret and Viale, 1954;Martin et al, 1962], arteria propria pancreatis [ Weisz and Bianco. 1957] and arteria pan creatica dorsalis [ Woodbitrne and Olsen, 1951;Galas et ah, 1956;Michels, 1955], Its incidence varies from exceptional [Rossi and Cova 1904;Vow.…”