Cadaveric, Ductal anatomy, Magnetic resonance cholangiopancreatography, Major pancreatic duct, Pancreatitis, Retrospective study
Citation Information :
Singh A, Prakash S, Rustagi SM. Anatomical Description of the Duct System of the Pancreas: A Cadaveric and Magnetic Resonance Cholangiopancreatography Study. Journal of Medical Academics 2022; 5 (1-2):6-11.
Introduction: Variations in the duct system of the pancreas lead to anomalies that predispose to diseases like acute or chronic pancreatitis or impairment of the pancreatic exocrine function. Pancreas divisum is the most common ductal anomaly leading to chronic pancreatitis.
Objectives: This study was aimed at observing, understanding, and analyzing recorded variations of the ductal anatomy of the pancreas with the purpose of reviewing the literature on pancreatic duct anatomy, and underlining its importance in daily invasive endoscopic and surgical practice.
Methods: A total of 10 cadaveric pancreas and duodenum were obtained en bloc from the abdomen. Following the injection of eosin dye for better visualization of the ducts, piecemeal dissection of the parenchyma of the gland was carried out to expose the duct system of the pancreas. A total of 10 outpatient department (OPD) cases of pancreatitis from the department of radiology in whom MRCP had been performed were chosen at random. The findings were interpreted, tabulated, compared with outcomes of previous studies, and analyzed.
Result: Our findings from the cross-sectional observational study suggest that out of twenty pancreas, 75% of cases showed the presence of major pancreatic ducts, and 25% of cases showed the presence of both main and accessory pancreatic ducts. MRCPs of patients with acute/chronic pancreatitis obtained from the Department of Radiology showed the presence of a single duct, suggesting that presence of single duct anatomy might be a predisposing condition for the occurrence of pancreatitis.
Conclusion: This knowledge is significant for planning diagnostic procedures and procedure-related complications. Magnetic resonance cholangiopancreatography (MRCP) is the investigation of choice for visualizing the pancreatic and biliary ductal anatomy as it is noninvasive and safe. Hence, based upon findings of the pancreatic ductal system using cadaveric pancreas and MRCP, associations between the patterns and anomalies with pancreaticobiliary diseases were assessed.
Dimitriou I, Katsourakis A, Nikolaidou E, et al. The main anatomical variations of the pancreatic duct system: review of the literature and its importance in surgical practice. J Clin Med Res 2018;10(5):370–375. DOI: 10.14740/jocmr3344w
Türkvatan A, Erden A, Türkoğlu MA, et al. Congenital variants and anomalies of the pancreas and pancreatic duct: imaging by magnetic resonance cholangiopancreaticography and multidetector computed tomography. Korean J Radiol 2013;14(6):905–913. DOI: 10.3348/kjr.2013.14.6.905
Schulte SJ, Stevenson GW, Freeny PC. Margulis’ and Burhenne's alimentary tract radiology. 5th ed. St. Louis: Mosby, 1994 p.1039–1051.
Susan standring. Gray's anatomy:the anatomical basis of clinical practice. 41st ed. London: Elsevier; 2016 p.1182
Jagielski M, Smoczynski M, Adrych K. The anatomical variations of pancreatic duct in the patients with pancreatic diseases. J Transl Clin Med 2018;1(1):61–64. DOI: 10.31373/ejtcm/92069
Itoh S, Ikeda M, Ota T, et al. Assessment of the pancreatic and intrapancreatic bile ducts using 0.5-mm collimation and multiplanar reformatted images in multislice CT. Eur Radiol 2003;13:277–285. DOI: 10.1007/s00330-002-1516-x
Bernard JP, Sahel J, Giovannini M, et al. Pancreas divisum is a probable cause of acute pancreatitis: a report of 137 cases. Pancreas 1990;5(3):248–254. DOI: 10.1097/00006676-199005000-00002
Adibelli ZH, Adatepe M, Imamoglu C, et al. Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients. Radiol Oncol 2016;50(4):370–377. DOI: 10.1515/raon-2016-0041
Pavone P, Panebianco V, Laghi A, et al. Cholangiopancreatography with magnetic resonance in the assessment of pancreatic ducts. Radiol Med 1997;94(1-2):61–67. PMID: 9424654.
Oracz G, Oralewska B, Pertkiewics J, et al. Chronic pancreatitis associated with anatomic anomalies of pancreatic duct in children. J Pediatr Gastroenterol Nutr 2006;42(5):E58.
Matos C, Metens T, Devière J, et al. Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology 1997; 203(2):435–441. DOI: 10.1148/radiology.203.2.9114101
Punwani S, Gillams AR, Lees WR. Non-invasive quantification of pancreatic exocrine function using secretin-stimulated MRCP. Eur Radiol 2003;13(2):273–276. DOI: 10.1007/s00330-002-1605-x
Soto JA, Alvarez O, Múnera F, et al. Traumatic disruption of the pancreatic duct: diagnosis with MR pancreatography. AJR Am J Roentgenol 2001;176(1):175–178. DOI: 10.2214/ajr.176.1.1760175
Kamisawa T, Okamoto A. Pancreatographic investigation of pancreatic duct system and pancreaticobiliary malformation. J Anat 2008;212(2):125–134. DOI: 10.1111/j.1469-7580.2007.00843.x
Reddy M, V V, C K LD. A study on anatomical variations of the pancreatic duct system. Int J Anat Res 2019;7(1.2):6144–6148. DOI: 10.16965/ijar.2018.424
Vitellas KM, Keogan MT, Spritzer CE, et al. MR cholangiopancreatography of bile and pancreatic duct abnormalities with emphasis on the single-shot fast spin-echo technique. Radiographics 2000;20(4):939–957. DOI: 10.1148/radiographics.20.4.g00jl23939
Kamisawa T. Clinical significance of the minor duodenal papilla and accessory pancreatic duct. J Gastroenterol 2004;39(7):605–615. DOI: 10.1007/s00535-004-1390-1
Prasanna LC, Rajagopal KV, Thomas HR, et al. Accessory pancreatic duct patterns and their clinical implications. J Clin Diagn Res 2015:9(3):AC05–AC07. DOI: 10.7860/JCDR/2015/11539.5660
Kamisawa T, Takuma K, Egawa N, et al. A new embryological theory of the pancreatic duct system. Dig Surg 2010;27:132–136. DOI: 10.1159/000286906
Mchonde GJ, Gesase AP. Termination pattern of the main and accessory pancreatic ducts among Tanzanians. Anat J of Afr 2014;3(1):223–227.
Ishaque I, Ilyas A, Khan O, et al. Role of magnetic resonance cholangiopancreatography (MRCP) in learning anatomical variations in pancreatic duct. J Pak Med Assoc 2020;70(3):472–476. DOI: 10.5455/JPMA.15767
Simkins S. Variations in the pancreatic ducts and the minor duodenal papilla. Am J Med Sci 1931;182:626–639. DOI: 10.1097/00000441-193111000-00004
Millbourn E. On the excretory ducts of the pancreas in man, with special reference to their relations to each other, to the common bile duct and to the duodenum. Acta Anat 1950;9(1-2):1–34. DOI: 10.1159/000140426
Gopalan DH, Vani M, Vijayaraghavan V. Study of retropancreatic position of pancreatic duct & pancreatico biliary ductal union in cadaveric specimen. Ind J Res 2016;5(5):37–39. DOI: 10.36106/paripex
Bülow R, Simon P, Thiel R, et al. Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population. Eur Radiol 2014;24(12):3142–3129. DOI: 10.1007/s00330-014-3359-7
Dugic A, Nikolic S, Mühldorfer S, et al. Clinical importance of main pancreatic duct variants and possible correlation with pancreatic diseases. Scand J Gastroenterol 2020;55(5):517–527. DOI: 10.1080/00365521.2020.1760345
Dawson W, Langman J. An anatomical-radiological study on the pancreatic duct pattern in man. Anat Rec 1961;139:59–68. DOI: 10.1002/ar.1091390109
Kim HJ, Kim MH, Lee SK, et al. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc 2022;55(7):889–896. DOI: 10.1067/mge.2002.124635
Baldwin WM. The pancreatic ducts in man, together with a study of the microscopical structure of the minor duodenal papilla. Anat Rec 1911;5:197–228. DOI: 10.1002/ar.1090050502
Dawson PM, Allen-Mersh TG. The anatomical relationship between the retropancreatic part of the bile duct and the main pancreatic duct. Ann R Coll Surg Engl 1983;65(3):188– 190. PMID: 6859784.
Xiao B, Zhang XM. Magnetic resonance imaging for acute pancreatitis. World J Radiol 2010;2(8):298–308. DOI: 10.4329/wjr.v2.i8.298
Parakh A, Tirkes T. Advanced imaging techniques for chronic pancreatitis. Abdom Radiol (NY) 2020;45(5):1420–1438. DOI: 10.1007/s00261-019-02191-0
Mitchell CJ, Lintott DJ, Ruddell WS, et al. Clinical relevance of an unfused pancreatic duct system. Gut 1979;20(12):1066–1071. DOI: 10.1136/gut.20.12.1066
Sullivan LM. Essentials of Radiology Images. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 1998. p. 511–544.
Bang S, Suh JH, Park BK, et al. The relationship of anatomic variation of pancreatic ductal system and pancreaticobiliary diseases. Yonsei Med J 2006;47(2):243–248. DOI: 10.3349/ymj.2006.47.2.243
Haaga JR. Computed tomography & magnetic resonance image of the whole body. 3rd ed. St. Louis: Mosby; 1994. p. 1035–1130.
Bhasin DK, Rana SS, Nanda M, et al. Ansa pancreatica type of ductal anatomy in a patient with idiopathic acute pancreatitis. J Pancreas 2006;7(3):315–320. PMID: 16685114.
Matsumoto Y, Fujii H, Itakura J, et al. Pancreaticobiliary maljunction: pathophysiological and clinical aspects and the impact on biliary carcinogenesis. Langenbecks Arch Surg 2003;388(2):122–131. DOI: 10.1007/s00423-003-0370-x