Yonsei Med J.  2006 Apr;47(2):243-248. 10.3349/ymj.2006.47.2.243.

The Relationship of Anatomic Variation of Pancreatic Ductal System and Pancreaticobiliary Diseases

• Bang S
• Suh JH
• Park BK
• Park SW
• Song SY
• Chung JB

• KMID: 1110749
• DOI: http://doi.org/10.3349/ymj.2006.47.2.243

Abstract

The aims of this study were to identify the morphological diversities and anatomical variations of pancreatic ductal system and to define the relationships between pancreatic ductal systems, pancreaticobiliary diseases, and procedure-related complications, including post-ERCP pancreatitis. This study included 582 patients in whom both pancreatic duct (PD) and common bile duct were clearly visible by ERCP. PD systems were categorized into four types according to the relationship between common bile duct and PD. In types A and B, Wirsung duct formed the main PD. In type C, Wirsung duct did not form the main PD. If PD system did not fall into any of these three types, it was categorized as type D. The distribution of types among pancreatic ducts examined was as follows: type A: 491 cases (84.4%), type B: 56 cases (9.6%), type C: 20 cases (3.4%), and type D: 15 cases (2.6%). The anomalous anatomic variations of PD systems were divided into migration, fusion, and duplication anomalies. PD anomalies were noted in 51 patients, of which 19 (3.3%) were fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum), and 32 (5.5%) were duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. However, post- ERCP hyperamylasemia was more frequently found in types C (41.7%), D (50%) and A (19.8%) than in type B (9.4%). In summary, whether Wirsung duct forms the main PD and the presence or absence of the opening of the Santorini duct are both important factors in determining the development of pancreatitis and hyperamylasemia after ERCP.

Keyword

ERCP; pancreatic duct; anatomical variation

MeSH Terms

Sex Factors
Pancreatitis/diagnosis/pathology
Pancreatic Ducts/*anatomy & histology/*pathology
Pancreatic Diseases/diagnosis
Middle Aged
Male
Humans
Female
Common Bile Duct/anatomy & histology/pathology
Cholangiopancreatography, Endoscopic Retrograde/*methods
Bile Ducts/*anatomy & histology/metabolism/pathology

Figure

• 

  Fig. 1 Classification of Pancreatic Ductal System. In types A and B, Wirsung duct formed the main PD, however, in type C, Wirsung duct did not form the main PD. In type A, Santorini duct is either obliterated or absent. Santorini duct of type B is an accessory PD and runs into the minor papilla of duodenum. If PD system did not fall into any of these 3 groups, it was classified as type D.

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