Variational anatomy of the pancreas viewed by modern imagistic methods

Abstract

Introduction. The anatomical variants and developmental abnormalities of the pancreas do not always manifest themselves, sometimes being accidentally find out, during abdominal ultrasound. In case of clinical manifestations of pancreatic variations, patients had such symptoms as: abdominal pain, nausea and vomiting, being diagnosed with acute pancreatitis, which later by modern imaging examination, such as computed tomography and cholangiopancreatography by nuclear magnetic imaging, confirm one of the structural deviations of the pancreas, or the passage and drainage of its excretory ducts. Aim of the study. To determine the morphological peculiarities and variation anatomy of the pancreas based on modern diagnostic methods. Materials and methods. The study was a retrospective, and descriptive one, conducted in the MSPI CRH Timofei Moşneaga, on a group of 15 patients, of both genders, aged between 21- 57 years, hospitalized with acute pancreatitis, during the years 2014-2015. The images of the computed tomography and the cholangiopancreatography by nuclear magnetic imaging from the observation sheets of the patients included in our study were analyzed. The investigations images highlighted the morphological structure of the pancreas, the path of the pancreatic ducts, and the types of their fusion with the common bile duct. Results. By computed tomography in 7 patients were identified 3 variants of structure of the pancreas: lobulated pancreas, determined in 2 cases, characterized by unusual contour of the head of the pancreas; diffuse fat infiltration of the pancreas in 2 cases, characterized by presence of adipose tissue throughout the structure of the organ; pancreatic hypoplasia - 1 case, characterized by a short, round pancreatic head and an underdeveloped body, with splenomegaly; congenital pancreatic cyst - 1 case, in which the cyst had a uniform contour with thin walls, located in the region of the pancreatic body; accessory pancreatic lobe - 1 case, located superior to the cervix, its duct opening into the Wirsung duct. The cholangiopancreatography identified 2 variants of course and 2 variants of pancreatic ducts fusion, found in 8 patients, aged between 30-57 years: sigmoid path of Wirsung duct was established in 3 cases; loop-shaped path of the Wirsung duct - 1 case; Wirsung and Santorini duct fusion - 2 cases; Santorini duct of sigmoid shape - 2 cases. Conclusions. The most informative methods for identifying variants and developmental abnormalities of the pancreas are computed tomography and cholangiopancreatography. Their timely detection is important in the therapeutic management of patients who clinically manifest symptoms of acute pancreatitis.