DOI QR코드

DOI QR Code

Congenital Variants and Anomalies of the Pancreas and Pancreatic Duct: Imaging by Magnetic Resonance Cholangiopancreaticography and Multidetector Computed Tomography

  • Turkvatan, Aysel (Department of Radiology, Turkiye Yuksek Ihtisas Hospital) ;
  • Erden, Ayse (Department of Radiology, Ankara University School of Medicine) ;
  • Turkoglu, Mehmet Akif (Department of General Surgery, Antalya University School of Medicine) ;
  • Yener, Ozlem (Department of Radiology, Turkiye Yuksek Ihtisas Hospital)
  • Received : 2013.03.21
  • Accepted : 2013.07.16
  • Published : 2013.11.01

Abstract

Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients, some of these anomalies may lead to various clinical symptoms such as recurrent abdominal pain, nausea and vomiting. Recognition of these anomalies is important because these anomalies may be a surgically correctable cause of recurrent pancreatitis or the cause of gastric outlet obstruction. An awareness of these anomalies may help in surgical planning and prevent inadvertent ductal injury. The purpose of this article is to review normal pancreatic embryology, the appearance of ductal anatomic variants and developmental anomalies of the pancreas, with emphasis on magnetic resonance cholangiopancreaticography and multidetector computed tomography.

Keywords

References

  1. Itoh S, Ikeda M, Ota T, Satake H, Takai K, Ishigaki T. Assessment of the pancreatic and intrapancreatic bile ducts using 0.5-mm collimation and multiplanar reformatted images in multislice CT. Eur Radiol 2003;13:277-285
  2. Itoh S, Fukushima H, Takada A, Suzuki K, Satake H, Ishigaki T. Assessment of anomalous pancreaticobiliary ductal junction with high-resolution multiplanar reformatted images in MDCT. AJR Am J Roentgenol 2006;187:668-675 https://doi.org/10.2214/AJR.05.0824
  3. Schulte SJ. Embryology, normal variation, and congenital anomalies of the pancreas. In: Stevenson GW, Freeny PC, Margulis AR, Burhenne HJ, eds. Margulis' and Burhenne's alimentary tract radiology, 5th ed. St. Louis: Mosby, 1994:1039-1051
  4. Mortele KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics 2006;26:715-731 https://doi.org/10.1148/rg.263055164
  5. 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;32:17-22 https://doi.org/10.1097/RCT.0b013e318064e723
  6. Kozu T, Suda K, Toki F. Pancreatic development and anatomical variation. Gastrointest Endosc Clin N Am 1995;5:1-30
  7. Quest L, Lombard M. Pancreas divisum: opinio divisa. Gut 2000;47:317-319 https://doi.org/10.1136/gut.47.3.317
  8. Soto JA, Lucey BC, Stuhlfaut JW. Pancreas divisum: depiction with multi-detector row CT. Radiology 2005;235:503-508 https://doi.org/10.1148/radiol.2352040342
  9. Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annular pancreas in adults. AJR Am J Roentgenol 2009;193:455-460 https://doi.org/10.2214/AJR.08.1596
  10. Rizzo RJ, Szucs RA, Turner MA. Congenital abnormalities of the pancreas and biliary tree in adults. Radiographics 1995;15:49-68; quiz 147-148 https://doi.org/10.1148/radiographics.15.1.7899613
  11. Nijs EL, Callahan MJ. Congenital and developmental pancreatic anomalies: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 2007;28:395-401 https://doi.org/10.1053/j.sult.2007.08.001
  12. 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;187:1544-1553 https://doi.org/10.2214/AJR.05.0774
  13. 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;87:53-57 https://doi.org/10.1002/jso.20087
  14. Alexander LF. Congenital pancreatic anomalies, variants, and conditions. Radiol Clin North Am 2012;50:487-498 https://doi.org/10.1016/j.rcl.2012.03.006
  15. 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:e217-e220
  16. Lang K, Lasson A, Müller MF, Thorlacius H, Toth E, Olsson R. Dorsal agenesis of the pancreas - a rare cause of abdominal pain and insulin-dependent diabetes. Acta Radiol 2012;53:2-4 https://doi.org/10.1258/ar.2011.110480
  17. Oeda S, Otsuka T, Akiyama T, Ario K, Masuda M, Taguchi S, et al. Recurrent acute pancreatitis caused by a gastric duplication cyst communicating with an aberrant pancreatic duct. Intern Med 2010;49:1371-1375 https://doi.org/10.2169/internalmedicine.49.3392

Cited by

  1. Annular Pancreas: A Cause of Gastric Outlet Obstruction in a 20-Year-Old Patient vol.15, pp.None, 2014, https://doi.org/10.12659/ajcr.891041
  2. Missing pancreatic isthmus during pancreaticoduodenectomy vol.2015, pp.3, 2015, https://doi.org/10.1093/jscr/rjv009
  3. MRI Findings of Intrinsic and Extrinsic Duodenal Abnormalities and Variations vol.16, pp.6, 2013, https://doi.org/10.3348/kjr.2015.16.6.1240
  4. Annular pancreas: the failure of side-to-side gastrojejunostomy anastomosis and the success of repair with Roux-en-Y gastrojejunostomy vol.24, pp.2, 2015, https://doi.org/10.13181/mji.v24i2.1207
  5. Imaging of the pancreatic duct by linear endoscopic ultrasound vol.4, pp.3, 2013, https://doi.org/10.4103/2303-9027.162997
  6. ''Ductal adenocarcinoma in anular pancreas'' vol.21, pp.suppl1, 2013, https://doi.org/10.1016/j.ijsu.2015.04.086
  7. Accessory pancreatic lobe with gastric duplication cyst: diagnostic challenges of a rare congenital anomaly vol.2015, pp.None, 2013, https://doi.org/10.1136/bcr-2014-207751
  8. Ectopic Opening of the Common Bile Duct Accompanied by Choledochocele and Pancreas Divisum vol.55, pp.9, 2013, https://doi.org/10.2169/internalmedicine.55.6240
  9. Pancreatic Lipomatosis: An Extensive Pictorial Review vol.100, pp.1, 2016, https://doi.org/10.5334/jbr-btr.1014
  10. Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system: MRCP findings of 1158 consecutive patients vol.50, pp.4, 2013, https://doi.org/10.1515/raon-2016-0041
  11. Afferent loop syndrome in a patient having incomplete annular pancreas vol.3, pp.1, 2013, https://doi.org/10.1259/bjrcr.20160015
  12. Transduodenal drainage of symptomatic walled-off pancreatic necrosis in a patient with ansa pancreatica anatomic variation vol.13, pp.1, 2013, https://doi.org/10.5114/aoms.2017.64724
  13. Agenesis of the dorsal pancreas associated with mucinous adenocarcinoma and cystic teratoma: a case report and literature review vol.5, pp.2, 2013, https://doi.org/10.1002/ccr3.797
  14. A rare case of choledochal cyst with pancreas divisum: case presentation and literature review vol.21, pp.1, 2013, https://doi.org/10.14701/ahbps.2017.21.1.52
  15. ROLE OF MRCP IN DIAGNOSING PANCREATICOBILIARY DISORDERS WITH SURGICAL AND HISTOPATHOLOGICAL CORRELATION- A PROSPECTIVE STUDY IN A TERTIARY CARE CENTRE, GGH, KAKINADA, ANDHRA PRADESH vol.4, pp.38, 2013, https://doi.org/10.18410/jebmh/2017/459
  16. A Rare Cause of Pancreatitis vol.153, pp.3, 2017, https://doi.org/10.1053/j.gastro.2017.03.065
  17. The Main Anatomical Variations of the Pancreatic Duct System: Review of the Literature and Its Importance in Surgical Practice vol.10, pp.5, 2013, https://doi.org/10.14740/jocmr3344w
  18. Neurog3-dependent pancreas dysgenesis causes ectopic pancreas in Hes1 mutant mice vol.145, pp.17, 2013, https://doi.org/10.1242/dev.163568
  19. Various Congenital Abnormalities and Anatomic Variants of the Pancreas: A Pictorial Review vol.103, pp.1, 2019, https://doi.org/10.5334/jbsr.1780
  20. Anomalien im pankreatikobiliären System vol.14, pp.4, 2019, https://doi.org/10.1007/s11377-019-0369-7
  21. The main radiologic findings in annular pancreas vol.52, pp.4, 2019, https://doi.org/10.1590/0100-3984.2017.0196
  22. Biliary anatomy and pancreatic duct variations: A cross-sectional study vol.26, pp.4, 2013, https://doi.org/10.4103/sjg.sjg_573_19
  23. Separate pancreatic ducts draining into a type IV choledochal cyst: simultaneous anatomical variants in a child suffering from cholelithiasis and acute pancreatitis vol.42, pp.4, 2013, https://doi.org/10.1007/s00276-019-02377-7
  24. Trifidum anomaly of the main pancreatic duct vol.20, pp.3, 2013, https://doi.org/10.1016/j.pan.2020.01.018
  25. Clinical importance of main pancreatic duct variants and possible correlation with pancreatic diseases vol.55, pp.5, 2013, https://doi.org/10.1080/00365521.2020.1760345
  26. Pancreas divisum inversus vol.33, pp.5, 2013, https://doi.org/10.1002/ca.23475
  27. A Rare Annular Pancreatic Anomaly vol.9, pp.38, 2020, https://doi.org/10.14260/jemds/2020/624