ANATOMIA DEZVOLTARII

PANCREASULUI

5 weeks

6 WEEKS

8 WEEKS

Fascii coalescen pancreas

Fascii posterioare: Treitz RDP dr+stg (cap),

Toldt retromezogastric (corp)
Fascii anterioare: Fredet PDP supra si
submezocolice

Pancreas - anomalii de dezvoltare

Pancreas divisum

- is the most common congenital anomaly of

the pancreatic ductal system (4%10% of the
population)
- results when the ventral and dorsal
pancreatic ducts fail to fuse
- the ventral duct (duct of Wirsung) drains
only the ventral pancreatic anlage
- the majority of the gland empties into the
minor papilla through the dorsal duct (duct of
Santorini)

Pancreas inelar

Axial CECT images in a 37-year-old man with annular pancreas.

Axial CECT image shows pancreatic tissue (white arrow) completely
encircling the second portion of the duodenum (black arrow)
consistent with an annular pancreas.

Pancreas ectopic
- 0.6%13.7% of the population
- stomach (26%38% of cases),
duodenum (28%36%), jejunum
(16%), Meckel diverticulum, ileum
- rarely, it occurs in the colon,
esophagus, gallbladder, bile ducts,
liver, spleen, umbilicus, mesentery,
mesocolon, omentum
- usually measures 0.52.0 cm in
its largest dimension (rarely up to 5
cm) and is located in the
submucosa in approximately 50%
of cases
- Ectopic pancreas in the
gastrointestinal tract is usually
asymptomatic
- complications such as stenosis,
ulceration, bleeding, and
intussusception may develop

CT scan obtained in a patient with abdominal pain

shows ectopic pancreatic tissue (arrow) within the
small bowel mesentery.

Agenezia, hipoplazia
- Total agenesis of the pancreas is extremely rare, is incompatible with life and it is associated
with other malformations such as gallbladder aplasia, polysplenia, and fetal growth retardation.
- Hypoplasia (partial agenesis) result from the absence of the ventral or dorsal anlage
- Absence of the dorsal anlage is visualized as a short or truncated pancreas and can be
partial or complete. It may be seen as a solitary finding or in association with heterotaxia
syndromes.
- Partial agenesis of the dorsal pancreas is relatively more common than agenesis of the
ventral portion, but complete agenesis of the dorsal pancreas is extremely rare.

Anomalii congenitale chisturi

- Congenital pancreatic cysts are exceedingly rare.
- They have a female predilection
- Typically manifest as an asymptomatic palpable mass or patients may also present
with epigastric pain, jaundice, and vomiting related to the compression of surrounding
structures
- These cysts can be single or multiple and are most commonly located in the tail and
body of the pancreas
- Multiple congenital cysts are associated with other anomalies, such as von Hippel
Lindau disease and hepatorenal polycystic disease.

Axial noncontrast CT shows complete fatty replacement of the

pancreas in a 24-year-old man with cystic fibrosis. No pancreatic
parenchyma is visible in its expected location (white outline).

Anatomie descriptiv pancreas

PANCREAS
CEFALIC
aspect anterior
1. pancreaticoduodenala dreapta
superiora,
gastro-epiploica
dreapta,
colica dreapta
superioara
2. fasciile PDP Fredet
supra si
submezocolice,
mezocolonul
transvers

PANCREAS CEFALIC
aspect posterior
1. plan
arterial
(arcadele
duodenopancreatice),
plan ductal
(coledoc,
pancreatic),
plan venos
(VP)
2. fascia
RDP Treitz
dreapta

PANCREAS CEFALIC
aspect posterior

3. VCI, vasele renale drepte, pilierii diafragmului, L2-L3

PANCREAS CEFALIC

- sup: D1 tuberculii pre si retroD

(cel retroD = tubercul omental,
intraperitoneal)
- dr: D2 ductele pancreatice
- inf: D3 proc. Uncinat

- Pancreatic head and neck lobulations are defined as outpouchings of the gland more
than 1 cm beyond the anterior superior pancreaticoduodenal artery
- These variations are seen in approximately 34% of individuals upon close examination
- type I (anterior), seen in 10% of individuals;
- type II (posterior), seen in 19%;
- type III (horizontal), seen in 5%
- Another well-recognized pseudomass is a prominence on the anterior surface of the
pancreatic body to the left of the superior mesenteric vessels that abuts the posterior
surface of the lesser omentum. This entity is known as tuber omentale and should be
not misinterpreted as a true pancreatic neoplasm.

- Extreme pancreatic lipomatosis can be seen in cystic fibrosis and Shwachman-Diamond

syndrome, as well as in diabetic, obese, and elderly patients
- type 1a (35% of cases) is characterized by replacement of the head with sparing of the
uncinate process and peribiliary region;
- type 1b (36%), by replacement of the head, neck, and body, with sparing of the uncinate
process and peribiliary region;
- type 2a (12%), by replacement of the head, including the uncinate process, and sparing of
the peribiliary region;
- and type 2b (18%), by total replacement of the pancreas with sparing of the peribiliary
region

Gatul pancreasului
faa anterioar

- intre D1 si vasele mezenterice superioare

- faa anterioar coresp. Peretelui posterior al BO - raport cu pilorul prin BO

Gatul pancreasului
faa posterioar

- faa posterioar raport cu VMS si originea VP (Treitz drept

posterior de vase)

Corpul pancreasului faa anterioar

- retroperitoneal
- corespunde
peretelui posterior al
BO

Corpul pancreasului
fa posterioar

- plan venos: v. Splenica, v. MI

- fascia Toldt retromezogastric
- v. renala stanga, fata ant. a rinichiului stang

Corpul pancreasului

- faa inferioar mezocolic (supramezocolic)

- marginea superioar trunchi celiac, plex solar, arter splenic

Coada
pancreasului

Coada pancreasului

Pancreas vascularizaie arterial

1. PD sup
(GD)
2. PD inf
(MS)
3. P sup
(splenica)
4. P post
(splenica)
5. P inf
(MS)

Pancreas vascularizaie venoas

- PD sup
(GD)
- PD inf
(VMS)
- vv.
Corpului
(splenica/
trunchi
SM)

Pancreas limfatice

Pancreas limfatice

Pancreas inervaie

Segmentul duodeno-cefalic

Segmentul corporeocaudal

- din mugurii pancreatici ventral i

dorsal

- din mugurele dorsal, in grosimea

mezogastrului dorsal

- fixat la PPP cu ajutorul fasciilor RDP

Treitz

- corp fixat la PPP prin Toldt

retromezogastric
- coada libera in epiplonul
pancreatico-splenic

- poriuni supra i submezocolica

- poriunea submezocolica este
separata de inseria mezenterului n
alte 2 poriuni, dreapta si stanga

- situat in etjul supramezocolic, la

nivelul peretelui posterior al bursei
omentale

- vascularizatie hepato-mezenterica
superioara (arcadele duodenopancreatice)

- vascularizatie spleno-mezenterica
superioara

- extirpare in bloc
(duodenopancreatectomii cefalice)

- pancreatectomii corporeocaudale
(decolare coloepiploica si patrundere
in BO)