Advertisement

Surgical and Radiologic Anatomy

, Volume 40, Issue 4, pp 407–413 | Cite as

Circumportal pancreas: prevalence, subtypes and vascular variations of 55 patients

  • Erdem Yilmaz
  • Ahmet Celik
Original Article

Abstract

Purpose

To determine the frequency of circumportal pancreas (CP), and accompanying ductal and vascular anatomy variations.

Methods

Thin-section multidetector computed tomography of 6813 consecutive patients was retrospectively reviewed. Two radiologists evaluated CP presence with consensus. Concomitant pancreatic ductal and vascular variations were recorded. The course of the pancreatic duct was classified according to the portal vein as anteportal and retroportal, and pancreas fusion level classified according to splenic vein as suprasplenic, infrasplenic and mixed type.

Results

A total of 55 (0.8%) CP cases were detected. Six suprasplenic subtype cases were excluded from the classification, because the pancreatic ducts were not clearly distinguishable. Suprasplenic anteportal (45/49, 92%), infrasplenic anteportal (2/49, 4%), suprasplenic retroportal (1/49, 2%), and mixed anteportal subtypes (1/49, 2%) were detected. There were vascular variations in 16 cases (29%). 13/16 (81%) of vascular variations were detected on suprasplenic anteportal subtype. Most of them were replaced right hepatic artery from the superior mesenteric artery (n: 6).

Conclusions

CP is a rare but important pancreatic fusion anomaly. Suprasplenic anteportal CP is the most common subtype and other subtypes are very rare. Replaced right hepatic artery from the superior mesenteric artery is the most frequent vascular variation associated with CP. Identifying the CP and defining the pancreatic duct and vascular variations are important to prevent possible complications in patients undergoing pancreatic surgery.

Keywords

Circumportal pancreas Portal annular pancreas CT Vascular variations 

Notes

Acknowledgements

We would like to thank Begoña Rodrigez Rueda, medical illustrator from the Department of Graphic Design at Trakya University, Faculty of Fine Arts for drawing Figs. 1 and 2.

Author contributions

E Yilmaz: project development, data collection, manuscript writing. A Celik: data collection.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

276_2018_1975_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 KB)

References

  1. 1.
    Arora A, Velayutham P, Rajesh S, Patidar Y, Mukund A, Bharathy KG (2014) Circumportal pancreas: a clinicoradiological and embryological review. Surg Radiol Anat 36:311–319.  https://doi.org/10.1007/s00276-013-1189-y CrossRefPubMedGoogle Scholar
  2. 2.
    Connelly TM, Sakala M, Tappouni R (2015) Circumportal pancreas: a review of the literature and image findings. Surg Radiol Anat 37:431–437.  https://doi.org/10.1007/s00276-015-1436-5 CrossRefPubMedGoogle Scholar
  3. 3.
    Gonoi W, Akahane M, Akai H, Hagiwara K, Kiryu S, Hayashi N, Ohtomo K (2011) Retroportal main pancreatic duct with circumportal pancreas: radiographic visualization. Clin Imaging 35:442–446.  https://doi.org/10.1016/j.clinimag.2011.01.002 CrossRefPubMedGoogle Scholar
  4. 4.
    Harnoss JM, Harnoss JC, Diener MK, Contin P, Ulrich AB, Büchler MW, Schmitz-Winnenthal FH (2014) Portal annular pancreas: a systematic review of a clinical challenge. Pancreas 43:981–986.  https://doi.org/10.1097/MPA.0000000000000186 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hashimoto Y, Ross AS, Traverso LW (2009) Circumportal pancreas with retroportal main pancreatic duct. Pancreas 38:713–715.  https://doi.org/10.1097/MPA.0b013e3181a910ca CrossRefPubMedGoogle Scholar
  6. 6.
    Hikspoors JPJM., Peeters MMJP., Mekonen HK et al (2017) The fate of the vitelline and umbilical veins during the development of the human liver. J Anat 231:718–735.  https://doi.org/10.1111/joa.12671 CrossRefPubMedGoogle Scholar
  7. 7.
    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.  https://doi.org/10.1007/s13244-011-0092-5 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Joseph P, Raju RS, Vyas FL, Eapen A, Sitaram V (2010) Portal annular pancreas. A rare variant and a new classification. JOP 11:453–455PubMedGoogle Scholar
  9. 9.
    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.  https://doi.org/10.1016/j.surg.2009.03.018 CrossRefPubMedGoogle Scholar
  10. 10.
    Kin T, Shapiro J (2012) Re: article by Gonoi et al. Clin Imaging 36:84.  https://doi.org/10.1016/j.clinimag.2011.07.003 CrossRefPubMedGoogle Scholar
  11. 11.
    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.  https://doi.org/10.1007/s00595-012-0280-z CrossRefPubMedGoogle Scholar
  12. 12.
    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.  https://doi.org/10.1097/rct.0b013e3180557448 CrossRefPubMedGoogle Scholar
  13. 13.
    Luu AM, Braumann C, Herzog T, Janot M, Uhl W, Chromik AM (2017) Circumportal pancreas-a must know pancreatic anomaly for the pancreatic surgeon. J Gastrointest Surg 21:344–351.  https://doi.org/10.1007/s11605-016-3315-8 CrossRefPubMedGoogle Scholar
  14. 14.
    Marjanovic G, Obermaier R, Benz S, Bley T, Juettner E, Hopt UT, Adam U (2007) Complete pancreatic encasement of the portal vein: surgical implications of an extremely rare anomaly. Langenbecks Arch Surg 392:489–491.  https://doi.org/10.1007/s00423-006-0123-8 CrossRefPubMedGoogle Scholar
  15. 15.
    Sugiura Y, Shima S, Yonekawa H, Yoshizumi Y, Ohtsuka H, Ogata T (1987) The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery. Jpn J Surg 17:182–185CrossRefPubMedGoogle Scholar
  16. 16.
    Tappouni R, Perumpillichira J, Sekala M, Hosseinzadeh K, Clark C, Leyendecker J (2015) Circumportal pancreas: imaging findings in 40 patients. Abdom Imaging 40:521–530.  https://doi.org/10.1007/s00261-014-0242-6 CrossRefPubMedGoogle Scholar
  17. 17.
    Yamamoto S, Kubota K, Rokkaku K, Nemoto T, Sakuma A (2005) Disposal of replaced common hepatic artery coursing within the pancreas during pancreatoduodenectomy: report of a case. Surg Today 35:984–987CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiology, Faculty of MedicineTrakya UniversityEdirneTurkey

Personalised recommendations