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

Abstract

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.

Cadaveric Study of the Anatomical Variations of the Accessory Pancreatic Duct

“…8 . It may be mentioned that in one instance in this study, after the minor papilla had been cannulated the accessory pancreatic duct was demonstrated to be the main drainage system for that pancreas, as supported by Bang et al 19 .…”

Down's syndrome, duodenal atresia with paradoxical presence of distal bowel gas

“…Pancreatic duct anatomy can be categorized into four types. 5 In types A and B, Wirsung duct is the main pancreatic duct and drains into the major papilla of the duodenum. In type A, Santorini duct is obliterated or absent.…”

“…Pancreatic ductal systems other than types A, B and C are defined as type D. In our patient, the presence of two ducts and two duodenal papillae indicates a type B or C pancreatic duct system anomaly. 5 In patients who have duodenal atresia and simultaneously have type B or type C pancreatic ductal system, duodenal atresia develops in the area between the two papillae. If the papillae are incompetent, they will allow gas to flow from the proximal duodenum into the duct of Santorini above the area of atresia, and from there gas can enter the duct of Wirsung below the atresia and flow into the distal duodenum.…”

Surgical Morphology of the Pancreatic Isthmus

“…the part of the gland situated above the venous confluence, is frequently used as a site of transection by surgeons due to its thinness. Our study focuses on elucidating the anatomic and morphological features of the pancreatic isthmus as a site for surgical transection [5,11,21]. …”

“…Pancreatic duct type and distribution were classified by three blinded pancreatologists according to the classification proposed by Bang et al [11]. Results underwent Cohen’s ĸ test (correlation/reliability) between categorization pairs of the same individual.…”