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Pancreas

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Surgery

Abstract

The pancreas is derived as an outpouching of the primitive foregut endoderm in the region of the duodenum. It has two main embryologic components: (1) a dorsal bud, first identifiable at 4 weeks gestation, that goes on to become the body and tail of the gland and (2) a ventral bud that produces the head of the gland and the extrahepatic biliary system (Fig. 46.1). As these outpouchings grow, the ventral aspect rotates to fuse with the dorsal aspect by about the seventh week of gestation. The ductal system of the pancreas is derived from these two anlages. The embryonic ventral duct arises from the bile duct, drains with it into the duodenum at the major papilla, and fuses with the dorsal duct to drain the body of the gland as the main pancreatic duct of Wirsung. The embryonic dorsal duct persists as a separate structure in its proximal portion (duct of Santorini), draining into the duodenum at the minor papilla on the medial duodenal wall about 1–2 cm cephalad to the major papilla. In 5%–10% of people, the ventral and dorsal ducts fail to fuse, resulting in a condition known as pancreas divisum.1 In this anatomical arrangement, the majority of pancreatic secretions are carried to the duodenum through the duct of Santorini and the minor papilla (Fig. 46.2).

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Authors and Affiliations

  1. Department of Surgery, University of Utah, Salt Lake City, UT, USA

    Robert E. Glasgow MD (Assistant Professor)

  2. Department of Surgery, The University of Utah, Salt Lake City, UT, USA

    Sean J. Mulvihill MD (Professor and Chair and Senior Director of Clinical Affairs)

  3. Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA

    Sean J. Mulvihill MD (Professor and Chair and Senior Director of Clinical Affairs)

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  1. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    Jeffrey A. Norton MD, FACS (Robert L. and Mary Ellenburg Professor, Chief) (Robert L. and Mary Ellenburg Professor, Chief)

  2. Divisions of Surgical Oncology and General Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    Jeffrey A. Norton MD, FACS (Robert L. and Mary Ellenburg Professor, Chief) (Robert L. and Mary Ellenburg Professor, Chief)

  3. Departments of Surgery and Public Health, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA

    Philip S. Barie MD, MBA, FCCM, FACS (Professor, Chief) (Professor, Chief)

  4. Division of Critical Care and Trauma, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA

    Philip S. Barie MD, MBA, FCCM, FACS (Professor, Chief) (Professor, Chief)

  5. Departments of Surgery and Immunology, Duke University Medical Center, Durham, NC, USA

    R. Randal Bollinger MD, PhD, FACS (Professor) (Professor)

  6. Division of Surgical Oncology, Department of Surgery, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI, USA

    Alfred E. Chang MD, FACS (Chief, Hugh Cabot Professor of Surgery) (Chief, Hugh Cabot Professor of Surgery)

  7. Department of Surgery, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA

    Stephen F. Lowry MD, MBA, FACS (Professor and Chairman) (Professor and Chairman)

  8. Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Stephen F. Lowry MD, MBA, FACS (Professor and Chairman) (Professor and Chairman)

  9. Department of Surgery, The University of Utah, Salt Lake City, UT, USA

    Sean J. Mulvihill MD, FACS (Professor and Chair, Senior Director of Clinical Affairs) (Professor and Chair, Senior Director of Clinical Affairs)

  10. Huntsman Cancer Institute, The University of Utah, Salt Lake City, UT, USA

    Sean J. Mulvihill MD, FACS (Professor and Chair, Senior Director of Clinical Affairs) (Professor and Chair, Senior Director of Clinical Affairs)

  11. Departments of Cardiothoracic Surgery and Surgery, New York University Medical Center, New York, NY, USA

    Harvey I. Pass MD, FACS (Professor) (Professor)

  12. Radiology, and Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO, USA

    Robert W. Thompson MD, FACS (Professor of Surgery (Section of Vascular Surgery), Vice-Chairman for Research) (Professor of Surgery (Section of Vascular Surgery), Vice-Chairman for Research)

  13. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Robert W. Thompson MD, FACS (Professor of Surgery (Section of Vascular Surgery), Vice-Chairman for Research) (Professor of Surgery (Section of Vascular Surgery), Vice-Chairman for Research)

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© 2008 Springer Science+Business Media, LLC

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Glasgow, R.E., Mulvihill, S.J. (2008). Pancreas. In: Norton, J.A., et al. Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-68113-9_47

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  • DOI: https://doi.org/10.1007/978-0-387-68113-9_47

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