Evaluation and Management of Pancreatic Injuries

Retroperitoneum

Extends obliquely at the level of L1 and L2 vertebra

Head of the Pancreas

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  Located in the C-loop of the duodenum

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  On the right side of the superior mesenteric vessels

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  Important structures posterior to the head:

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    Inferior vena cava (IVC)

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    Hilum of the right kidney

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    Right renal vein

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    Common bile duct (CBD)

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  Medial side of the head is in close contact with the duodenum.

Uncinate process of the pancreas

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  Extension of the head of the pancreas

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  Situated posterior to the superior mesenteric vessels

Neck of the pancreas

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  Situated anterior to the superior mesenteric vessels

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  Important posterior structures

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    Superior mesenteric artery

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    Superior mesenteric vein

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    Proximal portal vein

Body and tail of the pancreas

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  Situated on the left side of the mesenteric vessels

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  Important structures posterior to the body

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    Suprarenal aorta

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    Left renal vessels

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    Splenic vein

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    Inferior mesenteric vein, which joins the splenic vein

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  Splenic artery runs along the superior border of the pancreas.

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  Tail of the pancreas is in close contact with the hilum of the spleen.

Main pancreatic duct (Wirsung duct)

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  Runs in the entire length of the pancreas

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  Joins the CBD to drain into the ampulla of Vater

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  Ampulla of Vater drains into the medial wall of the second part of the duodenum (D2) through the major papilla.

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  Both the CBD and the pancreatic duct enter the duodenum through a separate ampulla in 10% of the population.

Accessary pancreatic duct (duct of Santorini)

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  Present in approximately 30% of the patient population

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  Drains into the second part of the duodenum, usually proximal and dorsal to the main pancreatic duct through the minor papilla (70%), or may drain directly (30%) into the main pancreatic duct

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  In pancreas divisum (failure of the fusion of the ventral and dorsal pancreatic ductal systems), the majority of the pancreas is drained through the accessory duct into the minor papilla.

Head of the pancreas

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  Superior pancreaticoduodenal artery

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    Branch from gastroduodenal artery

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    Divides to form anterior and posterior pancreaticoduodenal arcades

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  Inferior pancreaticoduodenal artery

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    Branch from superior mesenteric artery.

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    Divides to form anterior and posterior pancreaticoduodenal arcades.

Body and tail of the pancreas

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  Branches from the splenic artery including the:

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    greater pancreatic artery.

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    dorsal pancreatic artery.