Spatial arrangement of the pancreatic ducts in the head of the pancreas with special reference to the branches of the uncinate process

Abstract

Background: It remains very difficult to clarify the spatial arrangement of the branches of the pancreatic ducts in the head of the pancreas despite recent progress in diagnostic imaging techniques. Methods: We minutely dissected the head region from 15 cadavers after injection of silicone rubber into the ducts through the papilla of Vater to investigate the distribution of these ducts. Results: We found that the branches that drained the uncinate process not only joined the main pancreatic duct but also constantly joined the accessory pancreatic duct. In addition, the branches of the uncinate process that joined the accessory duct ran anterior to those to the main duct. We classified the arrangement of the pancreatic ducts into type 1 (10 cases) and type 2 (5 cases) on the basis of the pattern of the branches of the uncinate process. The distance from the papilla of Vater to the junction of the main and accessory pancreatic ducts in type 1 (>23.0 mm) was significantly longer than that in type 2 (<22.0 mm). Conclusions: Careful attention should be paid to the branches of the uncinate process to the accessory pancreatic duct to enable more accurate diagnoses of the pancreas head region. (Surgery 1999;125:178-85.)