Abstract
The pancreas is a digestive organ with both exocrine and endocrine functions that sits in the retroperitoneum at the level of the second lumbar vertebra. It has an extremely close spatial relationship with multiple organs (i.e., the duodenum, stomach, transverse colon, and bile duct) and multiple major blood vessels, including the celiac axis, superior mesenteric artery and vein, portal vein, and vena cava. Acknowledgment and understanding of these close proximities is vital when performing surgical procedures involving the pancreas. Knowledge of pancreatic embryology is also key for the identification of congenital anomalies and their relevance for patients. An in-depth understanding of overall pancreatic anatomy and normal variants is also critical for the proper diagnosis and treatment of any potential resulting pancreatic pathology. Anatomic anomalies and variations of the pancreas include pancreas divisum, annular pancreas, ectopic pancreas, pancreatic agenesis and hypoplasia, pancreatic cysts, and variations of the course and configuration of the duct.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Riall TS. Pancreas anatomy and physiology. In: Mulholland MW, Lillemoe KD, Doherty GM, Maier RV, Simeone DM, Upchurch Jr GR, editors. Greenfield’s surgery: scientific principles and practice. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 799–818.
Blumgart LH, Hann LE. Surgical and radiologic anatomy of the liver, biliary tract, and pancreas. In: Blumgart LH, editor. Surgery of the liver, biliary tract, and pancreas. Philadelphia: Saunders Elsevier; 2007. p. 3–29.
Tadokoro H, Takase M, Nobukawa B. Development and congenital anomalies of the pancreas. Anat Res Int. 2011;2011:351217.
Mortelé KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006;26(3):715–31.
Rizzo RJ, Szucs RA, Turner MA. Congenital abnormalities of the pancreas and biliary tree in adults. Radiographics. 1995;15(1):49–68; quiz 147–8.
Drake RL, Vogl W, Mitchell AWM. Abdomen: regional anatomy. In: Drake RL, Vogl W, Mitchell AWM, editors. Gray’s anatomy for students. Philadelphia: Saunders Elsevier; 2005. p. 242–343.
Borghei P, Sokhandon F, Shirkhoda A, Morgan DE. Anomalies, anatomic variants, and sources of diagnostic pitfalls in pancreatic imaging. Radiology. 2013;266(1):28–36.
Schulte SJ. Embryology, normal variation, and congenital anomalies of the pancreas. In: Stevenson GW, Freeny PC, Margulis AR, Burhenne AR, editors. Margulis’ and Burhenne’s alimentary tract radiology. St. Louis: Mosby; 1994. p. 1039–51.
Howard TJ. Pancreas divisum and other variants of dominant dorsal duct anatomy. In: Cameron JL, Cameron AM, editors. Current surgical therapy. Philadelphia: Elsevier; 2011. p. 393–8.
Agha FP, Williams KD. Pancreas divisum: incidence, detection, and clinical significance. Am J Gastroenterol. 1987;82(4):315–20.
Kozu T, Suda K, Toki F. Pancreatic development and anatomical variation. Gastrointest Endosc Clin N Am. 1995;5(1):1–30.
Lehman GA, Sherman S. Diagnosis and therapy of pancreas divisum. Gastrointest Endosc Clin N Am. 1998;8(1):55–77.
Soto JA, Lucey BC, Stuhlfaut JW. Pancreas divisum: depiction with multi-detector row CT. Radiology. 2005;235(2):503–8.
Bret PM, Reinhold C, Taourel P, Guibaud L, Atri M, Barkun AN. Pancreas divisum: evaluation with MR cholangiopancreatography. Radiology. 1996;199(1):99–103.
Morgan DE, Logan K, Baron TH, Koehler RE, Smith JK. Pancreas divisum: implications for diagnostic and therapeutic pancreatography. AJR Am J Roentgenol. 1999;173(1):193–8.
Yu J, Turner MA, Fulcher AS, Halvorsen RA. Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: part 2, Pancreatic duct and pancreas. AJR Am J Roentgenol. 2006;187(6):1544–53.
Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annular pancreas in adults. AJR Am J Roentgenol. 2009;193(2):455–60.
Türkvatan A, Erden A, Türkoğlu MA, Yener Ö. 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):905–13.
Lecesne R, Stein L, Reinhold C, Bret PM. MR cholangiopancreatography of annular pancreas. J Comput Assist Tomogr. 1998;22(1):85–6.
Nijs EL, Callahan MJ. Congenital and developmental pancreatic anomalies: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR. 2007;28(5):395–401.
Thoeni RF, Gedgaudas RK. Ectopic pancreas: usual and unusual features. Gastrointest Radiol. 1980;5(1):37–42.
Eisenberger CF, Gocht A, Knoefel WT, Busch CB, Peiper M, Kutup A, et al. Heterotopic pancreas – clinical presentation and pathology with review of the literature. Hepatogastroenterology. 2004;51(57):854–8.
Cho JS, Shin KS, Kwon ST, Kim JW, Song CJ, Noh SM, et al. Heterotopic pancreas in the stomach: CT findings. Radiology. 2000;217(1):139–44.
Emerson L, Layfield LJ, Rohr LR, Dayton MT. Adenocarcinoma arising in association with gastric heterotopic pancreas: a case report and review of the literature. J Surg Oncol. 2004;87(1):53–7.
Schnedl WJ, Piswanger-Soelkner C, Wallner SJ, Reittner P, Krause R, Lipp RW, et al. Agenesis of the dorsal pancreas and associated diseases. Dig Dis Sci. 2009;54(3):481–7.
Alexander LF. Congenital pancreatic anomalies, variants, and conditions. Radiol Clin N Am. 2012;50(3):487–98.
Low JP, Williams D, Chaganti JR. Polysplenia syndrome with agenesis of the dorsal pancreas and preduodenal portal vein presenting with obstructive jaundice – a case report and literature review. Br J Radiol. 2011;84(1007):e217–20.
Agarwala S, Lal A, Bhatnagar V, Dinda AK, Mitra DK. Congenital true pancreatic cyst: presentation and management. Trop Gastroenterol. 1999;20(2):87–8.
Auringer ST, Ulmer JL, Sumner TE, Turner CS. Congenital cyst of the pancreas. J Pediatr Surg. 1993;28(12):1570–1.
Boulanger SC, Borowitz DS, Fisher JF, Brisseau GF. Congenital pancreatic cysts in children. J Pediatr Surg. 2003;38(7):1080–2.
Matsumoto Y, Fujii H, Itakura J, Matsuda M, Nobukawa B, Suda K. Recent advances in pancreaticobiliary maljunction. J Hepato-Biliary-Pancreat Surg. 2002;9(1):45–54.
Kato O, Hattori K, Suzuki T, Tachino F, Yuasa T. Clinical significance of anomalous pancreaticobiliary union. Gastrointest Endosc. 1983;29(2):94–8.
Misra SP, Dwivedi M. Pancreaticobiliary ductal union. Gut. 1990;31(10):1144–9.
Cha SW, Park MS, Kim KW, Byun JH, Yu JS, Kim MJ, et al. Choledochal cyst and anomalous pancreaticobiliary ductal union in adults: radiological spectrum and complications. J Comput Assist Tomogr. 2008;32(1):17–22.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Cha, C., Hollander, L. (2021). Surgical Anatomy, Anomalies, and Normal Variants of the Pancreas. In: Narayan, D., Kapadia, S.E., Kodumudi, G., Vadivelu, N. (eds) Surgical and Perioperative Management of Patients with Anatomic Anomalies. Springer, Cham. https://doi.org/10.1007/978-3-030-55660-0_11
Download citation
DOI: https://doi.org/10.1007/978-3-030-55660-0_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-55658-7
Online ISBN: 978-3-030-55660-0
eBook Packages: MedicineMedicine (R0)