The relationship of the pancreatic part of the common bile duct to the head of the pancreas in Jamaicans - abstract

ABSTRACT

There is little conformity in the descriptions of the relationship of the common bile duct to the head of the pancreas in textbooks of Anatomy. It has also been suggested that there might be racial differences in the topographical relation of these structures. The pancreatic part of the common bile duct is of primary importance to the biliary surgeon, since it is often necessary to explore it during operations. In view of this it would seem useful to the biliary surgeon in the Caribbean to have basic data on its topographical relations. Duodenum-pancreas specimens of 234 persons of both sexes between the ages of 15 and 97 years were obtained from the postmortem cases in the Department of Pathology, UWI, Jamaica. The common bile duct (CBD) was carefully dissected under the dissecting microscope. The relationship of the CBD to the head of the pancreas could be classified into the following three types (Type I) the CBD was situated entirely in a groove of the posterior surface of the head of the pancreas and its posterior surface was not covered by pancreatic tissue 45 cases (19.2 percent); (Type II) The CBD lies in a deep groove, entirely or partially covered on its posterior side by a lingula of pancreatic tissue 170 cases (72.7 percent) and (Type III) The CBD is surrounded by pancreatic tissue 19 cases (8.1 percent). It would seem that in about 20 percent of cases (Type I) exploration of the pancreatic part of the CBD would not give problems. However, in the remaining 80 percent (Type II and III) pancreatic tissue was covering this part of the CBD. Although the CBD in Type II (72.7 percent) could easily be reached because of the presence of a cleavage plane filled with loose connective tissue, blood vessels of variable size were overbridging these cleavage planes. Cutting too many of these vessels would interfere with the blood circulation of the pancreatic lobule in that area with the possible consequence of the development of a postoperative pancreatitis. In Type III (8.1 percent of cases) it would be pratically impossible to expose the CBD without disturbing surrounding pancreatic tissue. Comparison with data from the literature revealed that for Type I there was no statistically significant difference, while for Type II and III, respectively there were marked differences. Although factors related to racial differences could have contributed to these differences, differences in the methods of investigation could not be excluded (AU)