Concept of a duct-to-mucosa pancreaticojejunostomy

The anatomy of the main pancreatic duct, as illustrated in Gray's Anatomy, comprises numerous branch ducts draining into the main pancreatic duct in a herringbone fashion. The presence of branch ducts is, of course, also well described in the present classification of intraductal papillary mucinous neoplasm (IPMN) into main duct and branch duct variants. During a standard Wirsungojejunostomy, the branch ducts are not engaged into the anastomosis and can logically "leak" outside the anastomosis, contributing to a postoperative pancreatic fistula (POPF). In fact, in rare cases a minor duct of Santorini may be present at the cut surface of the pancreas, and, if small and not identified, it will also not be engaged into aduct-to-mucosa anastomosis.

Chronic Relapsing Pancreatitis in a Child: Use of the Puestow Procedure to Achieve Ductal Drainage

A case of chronic relapsing pancreatitis presenting in an 8-year old African Jamaican girl is outlined. Aggressive supportive management failed to control pain and vomitting. The Puestow Procedure effectively aborted these symptoms. The use of the Puestow procedure should not be inordinately delayed in chronic relapsing pancreatitis if symptoms persist, since it may not only control pain but also halt declining pancreatic function.(Au)

A review of the aetiology and pathogenesis of acute pancreatitis Part II: Obstruction with hyper-secretion theory, alcoholism, vascular factors and trauma

Acute pancreatitis is generally accepted as being due to obstruction of the pancreatic duct and hyper-section but the activation of trypsinogen into trypsin is not fully understood. The value of trasylol in pancreatitis is debatable. The roles of alcoholism, circulatory disturbances and trauma in the aetiology of pancreatitis are discussed (AU)

Pancreatico-biliary duct system in Jamaicans

The anatomy of the pancreatico-biliary duct system in Jamaicans was investigated with the following results: 1. The incidence of the different patterns of union of the cystic and common hepatic ducts showed marked differences from data derived other populations. 2. The cystic and common hepatic ducts may have a common wall. 3. The incidence and course of aberrant bile ducts correspond to those in the literature. 4. The upper limit of normality of the flattened width of the common bile duct is suggested to be 11 mm. 5. The presence or absence of smooth muscle tissue in the common bile duct wall is discussed in relation to: (a) the role of the duct as a passageway of bile, (b) problems encountered when grafting, and (c) causation of biliary pain. 6. In 8.1 percent of cases it was difficult to expose the pancreatic part of the common bile duct because it was surrounded by pancreatic tissue. 7. In 9.4 percent of specimens the pancreatic part of the common bile duct coursed for the whole or part of its lenght alongside the medial wall of the duodenum without pancreatic tissue intervening between them. 8. In 19.3 percent of cases the duct of Santorini was as big as or bigger than the duct of Wirsung, a higher incidence than that reported elsewhere. 9. It appeared that no real sphincter exists at the duodenal end of the duct of Santorini. 10. The incidence of a common channel/ampulla (44.4 percent) was low if compared with the data in the literature. 11. The mucosa folds in the intramural parts of the common bile duct and the duct of Wirsung might play a significant role in the prevention of duodenal reflux and the regulation of the flow of bile and pancreatic secretion into the duodenum. 12. The variability in the component parts of the sphincter of Oddi was investigated. A sphincter choledochus was present in all cases, a common hepatopancreatic sphincter (=sphincter "ampullae") was found in 45.9 percent of cases, but a clearly-defined sphincter pancreaticus was not observed. 13. It is postulated that the presence or absence of a common hepatopancreatic sphincter may be one of the important factors in determining the patency or non-patency of the duct of Santorini at the papilla minor. The clinical and functional implications of these findings are discussed (AU)

Experimental studies on the aetiology of acute scorpion pancreatitis

This study examined the action of the venom of the scorpion Tityus trinitatis on the pancreas and gastrointestinal tract in anaesthetized dogs, on the isolated extracorporeal haemoperfused canine pancreas and on the isolated canine sphincter of Oddi. The venom induces exocrine secretion in both the isoslated and intact pancreas and causes contraction of the isolated sphincter of Oddi. These results are discussed in relation to the pathogenesis of acute scorpion pancreatitis and possibly of some other forms of acute pancreatitis. (Summary)