ARCHITECTONICS OF THE PANCREATIC DUCTS ON AUTOPSY

The aim of the study was to study the anatomical and topographical features of the common bile duct (CBD) and pancreatic ducts.

Material and methods. The study was performed on autopsy material obtained from 80 corpses (40 men and 40 women) aged 50 to 75 years. A complex topographic-anatomical and morphometric study of CBD, main (MPD) and accessory (APD) pancreatic ducts was conducted.

Results. The depth of CBD in the pancreas and the value of its diameter in men and women were established. The peculiarities of the formation of CBD were revealed. The values of the diameter of the MPD, its location and the features of the configuration within the organ are established. The ratio of different types of relative location of the terminal parts of the CBD and the duct of the pancreas is obtained. The incidence of APD and “pancreas divisum” in the study material was revealed.

Conclusion. The main drainage function in the pancreas is performed by the MPD. The sinuous structure of the duct is rare and indicates a possible violation of the fusion of the rudiment of the pancreas during embryogenesis. With a deep deposition of the MPD, the drainage is carried out through the APP, the frequency of occurrence of which was 83.7%. The presence of a divided system of pancreatic ducts, or "pancreas divisum", in the studied population is no more than 5.0% of cases. Knowledge of the architectonics of pancreatic ducts and anatomical and topographic variants of its development raises the quality of diagnosis with the use of modern equipment for radiation diagnosis in diseases of the pancreas.

1. Kirpatovskiy I. G., Smirnova E. D. Klinicheskaya anatomiya [Clinical Anatomy]. Kn. 1. M.: Meditsinskoe informatsionnoe agentstvo; 2003. 421 (in Russian).

2. Maev I. V., Kucheryavyy Yu. A. Bolezni podzheludochnoy zhelezy [Pancreatic diseases]. M.: GEOTARMedia; 2009. 736 (in Russian).

3. Paklina O. V., Karmazanovskiy G. G., Setdikova G. R. Patomorfologicheskaya i luchevaya diagnostika khirurgicheskikh zabolevaniy podzheludochnoy zhelezy [Pathomorphological and radiation diagnostics of surgical diseases of the pancreas]. M.: Vidar-M; 2013. 181 (in Russian).

4. Putov N. V., Artem'eva N. N., Kokhanenko N. Yu. Rak podzheludochnoy zhelezy [Pancreatic cancer]. SPb.: Piter, 2005 (in Russian).

5. Cubilla A. L., Fitzgerald P. J. Gross anatomy. In: Cubilla A.L., Fitzgerald P.J., editors. Tumors of the exocrine pancreas. Washington, DC: Armed forces institute of pathology; 1984: 31–52.

6. Lack E. E. Pathology of the pancreas, gallbladder, extrapancreatic biliary tract and ampullary region. Oxford; 2003. 586.

7. Kamisawa T., Tu Y., Egawa N. et al. Pancreatographic investigation of the pancreatic duct system. Surg Radiol Anat. 2007; 29: 405–408. doi: 10.1007/s00276-007-0220-6

8. Kamisawa T., Takuma K., Egawa N. et al. A new embryological theory of the pancreatic duct system. Dig Surg. 2010; 27: 132–136.

9. Kamisawa T., Takuma K., Tabata T., Egawa N. Clinical implications of accessory pancreatic duct. World J Gastroenterol. 2010; 16(36): 4499-4503. doi: 10.3748/wjg.v16.i36.4499

10. Prasanna L. C., D’Souza A. S., Rajagopal K. V., Bhat K. M. R. A study on the human pancreaticobiliary duct system and ampulla region with their clinical considerations. Indian J Gastroenterol. 2015; 34(1): 58–62.

11. Shukla P.J., Sakpal S.V., Maharaj R. Does pancreatic ductal anatomy play a role in determining outcomes of pancreatic anastomoses? Medical Hypotheses. 2011; 76: 230–233.

12. Steger U., Range P., Mayer F. et al. Pancreatic duct anatomy in the corpus area: implications for closure and anastomotic technique in pancreas surgery. Langenbecks Arch Surg. 2010; 395: 201– 206. DOI 10.1007/s00423-009-0526-4.