Surgical anatomy of the pancreas
Dr Farhana Jassat
Moderator: Dr K Singh
Outline
• Embryological
development
• Relationship to other
structures
• Pancreatic ductal
anatomy
• Arterial supply
• Venous drainage
• Lymphatic drainage
• Innervation
Embryology
4 th week: Hepatic bud
5th week :Formation of the pancreas
6th-7th week: Rotation of the pancreas
8th week: Fusion of the pancreas
Development of pancreatic cells
Secretory acini Pancreatic islets
Exocrine function only starts Endocrine function starts 10th-
after birth 15th week gestation
Anomalies of the pancreas
Agenesis, aplasia,
hypoplasia
Hyperplasia,
hypertrophy
Ectopic, accessory
pancreatic tissue
Annular pancreas
Pancreatic divisum
Anomalies: Annular pancreas
• Ring- like thin flat band
of pancreatic tissue
surrounding the 2nd
part of the duodenum
• Bowel obstruction
Theories of the embryogenesis of
annular pancreas
Ventral
pancreas
Dorsal
pancreas
Hypertrophy of both Adhesion of distal tip of
lobes ventral lobe to
duodenum
Fusion of aberrant
Paired ventral lobe pancreatic tissue
Anomalies: Pancreatic divisum
• Failure of the dorsal and ventral pancreatic duct
systems to join
• Pancreatitis- stenosis or infarction of one of the
ducts, insufficiency of the minor papilla
Topography/ Surface anatomy
• Soft, oblong-shaped
organ
• Transpyloric plane
• Epigastrium and left
hypochodrium regions
• Retroperitoneal
• Thin fibrous capsule
• Uncinate process,
Head, neck, body and
tail
Relationships to other structures
Body
Head
• Lies within the c shape
concavity of the duodenum
• Anterior surface
– Adjacent to pylorus, D1,
transverse colon
– Crossed by the attachment of the
root of the t/v mesocolon
– Anterior pancreaticoduodenal
arcade
• Posterior surface
– Abuts the right kidney, IVC, right
renal vessels, right gonadal vein
and right crus of the diaphragm
– Posterior pancreaticuoduodenal
arcade
Relationship of the CBD to the
posterior surface of the pancreas
Uncinate process
• Projection from the
lower part of the head
• Extends upward and left
• Posterior to
– SMA and SMV
• Anterior to
– Aorta and IVC
Relationship of the uncinate process
to the superior mesenteric vessels
Neck
• 1.5-2cm long, 3-4 cm
wide
• Anterior surface
– Covered in part by the
peritoneum of the lesser
sac , pyloroduodenal
junction, GDA
• Posterior surface
– Confluence of the SMV
and SV forming the PV
Body
• Anterior surface
– Antrum and body of the
stomach and transverse
mesocolon
• Superior border
– Celiac trunk, Splenic artery
• Posterior surface
– Aorta, origin of the SMA, left
crus of the diaphragm, left
kidney and its vessels, left
adrenal gland and SV
• Inferior surface
– Covered by peritoneum of
the greater sac, duodenal
jejunal flexure, coils of
jejunum, left colic flexure
• Middle part of body
• Overlies the lumbar spine
Tail
• Tapering end
• Abuts hilus of spleen
• Contained between the
two layers of the
splenorenal ligament
along with splenic
artery and vein
Pancreatic ductal anatomy
Main pancreatic duct of
Wirsung
• Begins near tail of pancreas
• Courses left to right and is
enlarged by additional ducts
• Through the tail and body-
the duct lies midway
• Turns caudal and posterior
on reaching the head
• At the level of the major
papilla turns horizontally to
join usually with the CBD
• Diameters- 4-5mm head/3-
4 mm body/2-3mm tail
Pancreatic ductal anatomy
Accessory pancreatic duct
of Santorini
• Frequently present (70%)
and usually
communicates with the
MPD
• Lies anterior to the CBD
• Usually drains into the
minor papilla – lies
proximal to the ampulla
of vater
Variations
Duct systems of the 2 Duct systems of the 2
buds fuse buds fuse
Connection of the Duct The connection of the
of Santorini to the duct of Santorini to the
duodenum may regress duodenum may persist
Variations
The duct systems of the Duct systems may fuse but
two buds may fail to lose their connection to the
ampulla
fuse giving rise to
• Pancreatic secretions then
“pancreas divisum”.
reach the duodenum
through the duct of
Santorini
Anatomic variations - union of the
CBD and the MPD at the major papilla
• “Common channel” refers to the fused portion of the
bile and pancreatic ducts proximal to entry into the
duodenum.
Long common channel Short common channel No common channel
Arterial supply
2 arterial systems
Head and uncinate
Body and tail
process
(Left coporo caudate
(Right cephalo cervical
segment)
segment)
Pancreatico duodenal
Splenic artery
arcade
Neck –watershed area
Arterial supply
SMA and artery first approaches
Hepatic artery variations
Accessory- in addition to
Replaced - in place of
Venous drainage
Follows arterial supply
Head and uncinate
Body and tail
process
Pancreatico duodenal Drain into the SV
veins above and Inferior
Drain into SMV and PV pancreatic vein below
Venous drainage
Variations of Henle’s gastrocolic trunk
Variations of IMV joining in the portal
venous system
38% 32.7% 29.3%
Lymphatic drainage
Japanese Pancreas Society
Innervation
Nerve supply
Sympathetic nervous Parasympathetic
system nervous system
Greater and lesser
splanchnic nerves- Vagus nerve
Celiac and SMA plexus
Inhibitory Stimulatory
Innervation
Chronic pancreatitis/ Pancreatic cancer – Celiac axis blocks
Thank you
References
• Sinnatamby, Chummy S -Lasts Anatomy
• Fischers Mastery of surgery
• Sabistons
• Langmans Medical embyrology
• www.pancreapedia.org- Anatomy and histology of the pancreas
