Abstract
Purpose
To analyze the CT and MR imaging features of circumportal pancreas (CP) with emphasis on the relative frequency of variants of parenchymal fusion, ductal anatomy, and vascular anatomy.
Methods
A retrospective review of CT and MR imaging findings of 40 patients with CP was performed. CT and MR images were reviewed by two radiologists in consensus. The course of the pancreatic duct in relation to the portal vein (anteportal vs. retroportal), location of the circumvenous pancreatic parenchyma in relation to the splenic vein (suprasplenic vs. infrasplenic), presence or absence of a visible accessory duct posterior to the portal vein, presence of vascular variants, history of pancreatitis and pancreatic surgery were recorded. Cases were classified into four categories: anteportal suprasplenic, retroportal suprasplenic, anteportal infrasplenic, and retroportal infrasplenic.
Results
One case of suprasplenic fusion was excluded from the classification due to non-visualization of the pancreatic duct. 32/39(82%) of cases were classified as anteportal suprasplenic, 2/39(5%) as retroportal suprasplenic, 4/39(10%) as anteportal infrasplenic, and 1/39(3%) as retroportal infrasplenic. There were 12 vascular variants including nine with an intraparenchymal course (through the pancreatic head) of the common hepatic artery, one with an intraparenchymal course of the right hepatic artery, two replaced right hepatic arteries from the superior mesenteric artery, and one with an intraparenchymal course of the left gastric vein.
Conclusion
Circumportal pancreas is an important pancreatic fusion anomaly with distinctive imaging features. The most common variant of CP is the anteportal suprasplenic subtype, with other subtypes being much less common. Intraparenchymal course of the common hepatic artery is a common variant associated with CP. Recognition of CP is important to avoid potential complications in patients who undergo pancreatic surgery.
Similar content being viewed by others
References
Bret PM, Reinhold C, Taourel P, et al. (1996) Pancreas divisum: evaluation with MR cholangiopancreatography. Radiology 199:99–103
Soto J, Lucey B, Stuhlfaut J (2005) Pancreas divisum: depiction with multi-detector row CT. Radiology 235:503–508
Morgan D, Logan K, Baron T, Koehler R, Smith J (1999) Pancreas divisum: implications for diagnostic and therapeutic pancreatography. AJR 173:193–198
Lecesne R, Stein L, Reinhold C, Bret PM (1998) MR cholangiopancreatography of annular pancreas. J Comput Assist Tomogr 22:85–86
Harold KL, Sturdevant M, Matthews BD, Mishra G, Heniford BT (2002) Ectopic pancreatic tissue presenting as submucosal gastric mass. J Laparoendosc Adv Surg Tech A 12:333–338
Sugiura Y, Shima S, Yonekawa H, et al. (1987) The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery. Jpn J Surg 17:182–185
Hamanaka Y, Evans J, Sagar G, Neoptolemos J (1997) Complete pancreatic encasement of the proximal hepatic portal vein: a previously undescribed congenital anomaly. Br J Surg 84:785
Marjanovic G, Obermaier R, Benz S, et al. (2007) Complete pancreatic encasement of the portal vein—surgical implications of an extremely rare anomaly. Langenbecks Arch Surg 392:489–491
Karasaki H, Mizukami Y, Ishizaki A, et al. (2009) Portal annular pancreas, a notable pancreatic malformation: frequency, morphology, and implications for pancreatic surgery. Surgery 146:515–518
Joseph P, Raju RS, Vyas FL, Eapen A, Sitaram V (2010) Portal annular pancreas. A rare variant and a new classification. J Pancreas 11:453–455
Leyendecker JR, Baginski SG (2008) Complete pancreatic encasement of the portal vein (circumportal pancreas): imaging findings and implications of a rare pancreatic anomaly. J Comput Assist Tomogr 32:61–64
Ferrer J, Scott WE III, Weegman BP, et al. (2008) Pig pancreas anatomy: implications for pancreas procurement, preservation, and islet isolation. Transplantation 86:1503–1510
Karasaki H, Mizukami Y, Ishizaki A, et al. (2009) Portal annular pancreas, a notable pancreatic malformation: frequency, morphology, and implications for pancreatic surgery. Surgery 146:515–518
Ishigami K, Tajima T, Nishie A, et al. (2011) The prevalence of circumportal pancreas as shown by multidetector-row computed tomography. Insights Imaging 2:409–414
Hashimoto Y, Ross AS, Traverso LW (2009) Circumportal pancreas with retroportal main pancreatic duct. Pancreas 38:713–715
Arora A, Velayutham P, Rajesh S, et al. (2014) Circumportal pancreas: a clinicoradiological and embryological review. Surg Radiol Anat 36:311–319
Yamaguchi K, Sato N, Minagawa N (2013) Sarcoidosis in a patient with a circumportal pancreas with a retroportal main pancreatic duct: a case report. Pancreas 42:1197–1199
Kobayashi S, Honda G, Kurata M, Okuda Y, Tsuruta K (2013) Pancreaticoduodenectomy in portal annular pancreas: report of a case. Surg Today 43:926–929
Muto J, Mano Y, Harada N, et al. (2012) Additional resection of the pancreas body prevents postoperative pancreas fistula in patients with portal annular pancreas who undergo pancreaticoduodenectomy. Case Rep Gastroenterol 6:131–134
Nakamura Y, Miyaki T, Hayashi S, Iimura A, Itoh M (2003) Three cases of the gastrosplenic and the hepatomesenteric trunks. Okajimas Folia Anat Jpn 80:71–76
Rammohan A, Sathyanesan J, Palaniappan R, Govindan M (2013) Transpancreatic hepatomesenteric trunk complicating pancreaticoduodenectomy. J Pancreas 14:649–652
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tappouni, R., Perumpillichira, J., Sekala, M. et al. Circumportal pancreas: imaging findings in 40 patients. Abdom Imaging 40, 521–530 (2015). https://doi.org/10.1007/s00261-014-0242-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-014-0242-6