Incidence and clinical implications of anatomical variations of the pancreas. A systematic review

Abstract

IntroductionThe pancreas is retroperitoneal gland located the posterior wall of the abdomen, and plays a central role in digestion and absorption, as well as in the use and storage of energy substrates. Due to its location, as an external organ deep in the retroperitoneum, its irregular surface, its smoothness, its close and varied relationships to adjacent structures, and its vague boundaries, its surgical intervention presents a challenge to the surgeon, hence knowing its anatomical variations is important information previous to consider.MethodsA systematized search of scientific articles and human anatomy books, written in Spanish or English, published between 1970 and 2020, was carried out in the following databases; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS and GOOGLE SCHOLAR, to describe the characteristics of the anatomical region of the pancreas and clinical complications.ResultsAfter applying the eligibility criteria 32 studies were included in this review, of which 2 described an annular pancreas, 3 described an ansa pancreatica, 3 mentioned a bifid pancreas, 5 mentioned a circumportal pancreas, 12 mentioned a pancreas divisum, 5 described ductal variations such as the course of the pancreatic duct or anomalies of the ductal system, 2 mentioned variations of the pancreaticobiliary Union and 2 described vascular variations of nearby vessels.ConclusionsWe found that the annular pancreas, PD, ansa pancreatica and bifid pancreas are variations that play a predisposing role in developing pancreatitis, the annular pancreas could also give operative complications in a pancreatic head resection surgery and postoperative complications such as pancreatic fistula, and biliary duct system variations appear to be predisposing factors to gallbladder stones formation. Hence, incorporating the study of its anatomical variations in the training of health professionals is very important for the process of diagnosis, monitoring and treatment of pancreatic diseases.