What comprises the plate-like structure between the pancreatic head and the celiac trunk and superior mesenteric artery? A proposal for the term \u201cP\u2013A ligament\u201d based on anatomical findings

Satoru Muro,Keiichi Akita,Daisuke Ban,Yuichi Nagakawa,Wachirawit Sirirat

doi:10.1007/s12565-020-00597-1

Abstract

A plate-like structure is located posterior to the portal vein system, between the pancreatic head and roots and/or branches of two major arteries of the aorta: the celiac trunk and superior mesenteric artery. We aimed to clarify the distribution and components of this plate-like structure. Macroscopic examination of the upper abdomen and histological examination of the plate-like structure were performed on 26 cadavers. The plate-like structure is connected to major arteries (aorta, celiac trunk, superior mesenteric artery) and the pancreatic head; it contains abundant fibrous bundles comprising nerves, vessels, collagen fibers, and adipose tissue. Furthermore, it consists of three partly overlapping fibrous components: rich fibrous bundles (superior mesenteric artery plexus) fused to the uncinate process of the pancreas; fibrous bundles arising from the right celiac ganglion and celiac trunk that spread radially to the dorsal side of the pancreatic head and superior mesenteric artery plexus; and fibrous bundles, accompanied by the inferior pancreaticoduodenal artery, entering the pancreatic head. The plate-like structure is the pancreas–major arteries (aorta, celiac trunk, superior mesenteric artery) ligament (P–A ligament). The term “P–A ligament” may be clinically useful and can facilitate comprehensive understanding of the anatomy surrounding the pancreatic head and provide an anatomical basis for further pancreatic surgery studies.

Highlights

Cancer of the pancreatic head often invades the superior mesenteric artery (SMA) (Nagakawa et al 1992; Nakao et al 1996, 2004; Makino et al 2008; Deshmukh et al 2010)
We examined the anatomy of the pancreatic head and surrounding structures from the viewpoint of pancreaticoduodenectomy (Fig. 1a)
On the dorsal side of the portal vein (PV) and superior mesenteric vein (SMV), a plate-like structure was found to be continuously fused to the uncinate process of the pancreas and celiac trunk (CeT)/SMA (Fig. 1b)

Summary

Introduction

Cancer of the pancreatic head often invades the superior mesenteric artery (SMA) (Nagakawa et al 1992; Nakao et al 1996, 2004; Makino et al 2008; Deshmukh et al 2010). Between the pancreatic head and the SMA is a Satoru Muro and Wachirawit Sirirat have contributed to this work This plate-like structure, located between the pancreatic head and the CeT/SMA, has been attributed two descriptions (Yoshioka and Wakabayashi 1985; Yi et al 2003; Gockel et al 2007; Agrawal et al 2010; Inoue et al 2015; Kanhere et al 2015). The term “mesopancreas” is reminiscent of an oncological benefit, none has been revealed It has been described as the pancreatic head plexus (Yoshioka and Wakabayashi 1985; Yi et al 2003). This anatomy of the nerve only partially describes the plate-like structure, including its thick

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