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Abdelgawad M, Wu D, Kamel O, Abdelgawad S, Ismael H. Management of Multiple Ducts at the Transected Pancreatic Neck in a Whipple Procedure. Am Surg 2024; 90:1815-1817. [PMID: 38616621 DOI: 10.1177/00031348241246177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Affiliation(s)
- Mohamed Abdelgawad
- Department of Surgery, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Diana Wu
- Carle Illinois College of Medicine, University of Illinois, Urbana-Champaign, IL, USA
| | - Omar Kamel
- St. George's University School of Medicine, Grenada, West Indies
| | - Sally Abdelgawad
- Department of Oral & Maxillofacial Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Hishaam Ismael
- Vice Chair of Surgical Education, Director of Surgical Oncology, Program Director for the General Surgery Residency, Department of Surgery, The University of Texas Health Northeast, Tyler, TX, USA
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Orellana-Donoso M, Milos-Brandenberg D, Benavente-Urtubia A, Guerra-Loyola J, Bruna-Mejias A, Nova-Baeza P, Becerra-Farfán Á, Sepulveda-Loyola W, Luque-Bernal RM, Valenzuela-Fuenzalida JJ. Incidence and Clinical Implications of Anatomical Variations in the Pancreas and Its Ductal System: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:1710. [PMID: 37629567 PMCID: PMC10455790 DOI: 10.3390/life13081710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE This systematic review analyzes the anatomical variants in the pancreas and its ductal system to report on their association with pancreatic pathologies. METHODS We conducted a search of the MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception to July 2023. The methodological quality was assessed with the Anatomical Quality Assessment (AQUA) tool. Finally, the pooled prevalence was estimated using a random effects model. RESULTS 55 studies were found that met the eligibility criteria. The overall prevalence of pancreas divisum (PD) was 18% (95% CI = 15-21%). The prevalence of PD associated with pancreatitis was 30% (95% CI = 1-61%). CONCLUSIONS An anatomical variant of the pancreas such as PD may be the cause of bile duct obstruction, resulting in various clinical complications, such as pancreatitis. Hence, knowing this variant is extremely important for surgeons, especially for those who treat the gastroduodenal region.
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Affiliation(s)
- Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7500000, Chile;
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Daniel Milos-Brandenberg
- Escuela de Medicina, Facultad Ciencias de la Salud, Universidad del Alba, Santiago 8320000, Chile;
| | - Andoni Benavente-Urtubia
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Javier Guerra-Loyola
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Alejandro Bruna-Mejias
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Álvaro Becerra-Farfán
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8370993, Chile;
| | - Walter Sepulveda-Loyola
- Faculty of Health and Social Sciences, Universidad de las Américas, Santiago 8370040, Chile;
| | - Ricardo Miguel Luque-Bernal
- Unidad de Anatomía, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá 111221, Colombia;
| | - Juan José Valenzuela-Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago 8370040, Chile
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Vassallo L, Fasciano M, Lingua G, Marchisio FG, Versiero M, Talenti A. Pancreas bifidum: an extremely rare cause of acute pancreatitis. Radiol Case Rep 2022; 17:3490-3494. [PMID: 35912297 PMCID: PMC9334921 DOI: 10.1016/j.radcr.2022.06.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022] Open
Abstract
A wide spectrum of anomalies of the pancreas, the pancreatic ductal system and the biliary tree are commonly encountered at radiologic evaluation. Pancreas bifidum, also known as bifid pancreas or fish-tail pancreas, is an extremely rare congenital branching anomaly of the main pancreatic duct characterized by its duplication. These 2 separate ducts are laid from the pancreatic tail to neck and they generally join at the pancreas body-tail draining via the major papilla; the pancreatic parenchyma is also bifurcated with separated dorsal and caudal buds. The clinical impact of this condition is not well established: although some authors sustained that probably does not cause or contribute to abdominal pain or overt pancreatic diseases, others argued that could be considered as a possible cause of acute pancreatitis. We herewith describe the case of a 51-year-old woman presenting to our hospital with epigastric pain, nausea, and vomiting. Biochemical tests were suspicious for acute pancreatitis. Ultrasound examination was negative. MRI, including MR cholangiopancreatography revealed bifid pancreas characterized by duplication of the main pancreatic duct with 2 separate ducts that join at the pancreas head and draining via the minor papilla. On T2-weighted images the ventral bud of the pancreas was enlarged and characterized by slightly hyperintensity without peripancreatic fluid collections. The MRI findings were consistent with acute pancreatitis limited to the ventral bud of a bifid pancreas. Patient was treated with intravenous fluid resuscitation, pain control and institution of early enteral nutrition and discharged on the seventh day after admission.
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Affiliation(s)
- Lorenzo Vassallo
- Unit of Radiology, Ospedale S.S. Annunziata, ASLCN1, Via degli Ospedali 9, 12038 Savigliano, Cuneo, Italy
- Corresponding author.
| | - Mirella Fasciano
- Unit of Radiology, Ospedale S.S. Annunziata, ASLCN1, Via degli Ospedali 9, 12038 Savigliano, Cuneo, Italy
| | - Gisella Lingua
- Unit of Radiology, Ospedale S.S. Annunziata, ASLCN1, Via degli Ospedali 9, 12038 Savigliano, Cuneo, Italy
| | - Federica Groppo Marchisio
- Unit of Radiology, Ospedale S.S. Annunziata, ASLCN1, Via degli Ospedali 9, 12038 Savigliano, Cuneo, Italy
| | - Marco Versiero
- Unit of Internal Medicine, Ospedale S.S. Annunziata, ASLCN1, Via degli Ospedali 9, 12038 Savigliano, Cuneo, Italy
| | - Alberto Talenti
- Unit of Radiology, Ospedale S.S. Annunziata, ASLCN1, Via degli Ospedali 9, 12038 Savigliano, Cuneo, Italy
- Unit of Radiology, Ospedale “Regina Montis Regalis”, ASLCN1, Via S. Rocchetto, 99, 12084 Mondovì, Cuneo, Italy
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Ouyang L, Hu H, Nie G, Yang LX, Huang ZP, Ni CM, Shao Z, Zheng KL, Jing W, Song B, Li G, Hu XG, Jin G. Incidence of bifid pancreatic duct in pancreaticoduodenectomy and its impact on clinically relevant postoperative pancreatic fistula. Front Oncol 2022; 12:934978. [PMID: 36059692 PMCID: PMC9428626 DOI: 10.3389/fonc.2022.934978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives This study aimed to examine the incidence of bifid pancreatic duct (BPD) in pancreaticoduodenectomy (PD) and clarify its impact on clinically relevant postoperative pancreatic fistula (CR-POPF). Background Until now, all the literature about BPD during PD are published as case reports, and the incidence of BPD in PD and its impact on CR-POPF remain unknown. Results A total of 438 consecutive PDs were divided into two groups: the former year group and the latter year group. The former year group included 215 consecutive PDs, while the latter year group included 223. In the latter year group, we found 16 BPDs during PD (O-BPD); the incidence of O-BPD is 7.17%. Of them, there were eight patients who had BPD in the preoperative imaging (I-BPD). All the I-BPDs are O-BPDs; which means that 50% of O-BPDs were a single pancreatic duct in the preoperative imaging (I-SPD). There were 17 I-BPDs in the 438 consecutive PDs; the incidence of I-BPD is 3.88%. In the former year group, the rate of severe complications of I-BPD and I-SPD is 77.78% and 27.18%, respectively (p = 0.003); the rate of CR-POPF of I-BPD is higher than I-SPD, 55.56% vs. 27.18%, but there were no statistically significant differences. In the latter year group, the rate of severe complications of O-BPD and O-SPD is 50% and 18.36%, and the rate of CR-POPF of O-BPD and O-SPD is 37.5% and 22.22%, respectively; both of them have statistically significant differences, and the p-value is 0.003 and 0.006, respectively. In the subgroup analysis, both the rate of severe complications and the rate of CR-POPF of I-BPD were higher than O-BPD, 77.78% vs. 50%, and 55.56% vs. 37.5%, but there were no statistically significant differences in both of them; the p-value is 0.174 and 0.434, respectively. Univariate and multivariate analyses showed that BPD was an independent risk factor of CR-POPF. Conclusions The incidence of O-BPD in PD is 7.17%, 50% of O-BPDs were I-SPD, and the incidence of I-BPD is 3.88%. BPD is an independent risk factor of CR-POPF. The suture closure method may be a simple, safe, and effective method in dealing with BPD in PD.
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Affiliation(s)
- Liu Ouyang
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hao Hu
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Gang Nie
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Li-xue Yang
- Department of Biliary Tract Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Zhi-ping Huang
- Department of Hepatobiliary Surgery, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Chen-ming Ni
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhuo Shao
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Kai-lian Zheng
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wei Jing
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bin Song
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Gang Li
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Gang Jin, ; Xian-gui Hu, ; Gang Li,
| | - Xian-gui Hu
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Gang Jin, ; Xian-gui Hu, ; Gang Li,
| | - Gang Jin
- Department of the Hepatobiliary and Pancreatic (HBP) Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Gang Jin, ; Xian-gui Hu, ; Gang Li,
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