A study on variations of the second part of the duodenum, the pancreas and the portal vein with applied aspects

Sulochana, S (2006) A study on variations of the second part of the duodenum, the pancreas and the portal vein with applied aspects. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: The duodenum and pancreas are the deepest-lying parts of the digestive tract. Anatomic relations between the duodenum, the pancreas and the surrounding structures are crucial to several disease processes. Knowledge of the anatomy of the duodenum will facilitate intubations and minimize risk. Until recently the small intestine had been relatively inaccessible for non-operative diagnostic procedures compared with stomach and colon. Several diagnostic techniques like mucosal biopsy, Enteroclysis, Selective Mesenteric Angiography, Scintigraphy and Fiberoptic Endoscopy are now available for specific diseases of the small bowel. The clinician and the endoscopist should be aware of the basic features of the small intestine structure as well as of regional variation in structure and function. Such knowledge greatly facilitates an understanding of the pathophysiology, evaluation and management of the small intestinal diseases, with the help of the modern diagnostic techniques. AIM OF THE STUDY The second part of the duodenum, the pancreas and the portal vein were studied with regard to 1. Dimensions of the duodenum: a) Length of the duodenum, b) Width of the duodenum, c) Length of the second part of the duodenum. 2. Duodenal papilla: a) Position of the major duodenal papilla, b) Opening of major duodenal papilla into the duodenum, c) Size of the major duodenal papilla, d) Shape of the major duodenal papilla, e) Shape of the orifice of major duodenal papilla, f) Distance between the pylorus and major duodenal papilla, g) Presence of minor duodenal papilla, h) Position of minor duodenal papilla, i) Size of minor duodenal papilla, j) Distance between minor and major papilla. 3. Pancreas: a. Length, b. Width of the Head, neck, body and tail, c. Shape, d. Termination of main pancreatic duct, 4. Portal vein: a) Formation of portal vein, b) Level of formation, c) Termination of inferior mesenteric vein, 5. Congenital anomalies, 6. Blood Supply, 7. Applied aspects. MATERIAL AND METHODS: Anatome – the name given to the science of anatomy by Aristotle two thousand three hundred years ago. The word means cutting up – the method by which the study of the structure of living things is made possible. Although ultrasonogrphy, Magnetic resonance imaging, Computed tomography, contrast radiography are advances in the investigatory methods in the living, manual dissection is still a valuable mode of study in the cadavers and this method is followed in the present study. MATERIALS: The 100 specimens for the present study were obtained from the cadavers of the Department of Anatomy and from the Department of Forensic Medicine, Thanjavur Medical College. The Specimens were collected without any age, sex, socio-economic status, religion or pathological bias. The Specimens were removed from the cadaver as per the Cunningham’s manual of Practical Anatomy. The abdominal cavity was opened by an incision extending from the xiphoid process to symphysis pubis. The greater omentum was exposed. The attachment of the gastrocolic ligament to the transverse colon was cut, turning the stomach and the ligament upwards, the posterior abdominal wall peritoneum was exposed. CONCLUSION: In the present study, the duodenum, the pancreas and the portal vein have been studied and the results compared with the earlier studies. The summary of the present study in human, in 100 specimens of duodenum and pancreas is as follows: • The dimensions of the duodenum were within normal limits in about 70%. • The major duodenal papilla was located in the second part of the duodenum in 94%, at the junction of I and II part in 5% and at the junction of II and III part in 1%. • The major papilla opened posteromedially into the duodenum in 79% and medially in 21%. • The size of the major papilla was in the range of 0.5 to 1 cm in 76%, 0.3 to 0.5cm in 12.5% and above 1 cm in 11.5%. • The shape of the major papilla was papillary in 96% and flat in 4%. • The shape of the orifice of the major papilla was round in 85% and slit-like in 15%. • The distance between the pylorus and the major papilla was in the normal range of 8 – 10 cm in 48%. The range was 7 – 8 cm in 30%, 5 - 7cm in 13% and 10 – 12cm in 9%. • The minor papilla was absent in 9%. • The minor papilla was located on the anterior wall of the duodenum in 100%. • The size of the minor papilla was in the range of 2 - 5 mm in 92.3%, 5-7mm in 5.5% and above 7mm in 2.2%. • The distance between the major and minor papilla was within the normal range of 1-2.5 cm in 84.6%. In 13.2%, the distance was 2.5 – 3.5cm and in 2.2%, it was less than 1cm. • The dimensions of the pancreas were within the normal limits in about 70%. • The shape of the pancreas was oblique in 87%, inverted V-shaped in 9% and sigmoid in 4%. • The union of the splenic vein and the superior mesenteric vein formed the portal vein in 74% and the confluence of the superior mesenteric, inferior mesenteric and splenic vein, in 26%. • The inferior mesenteric vein terminated in the splenic vein in 45%, in the superior mesenteric vein in 29% and in the junction of the splenic and superior mesenteric vein in 26%. • Duodenal diverticula were found in 5%, which were seen near the ampulla of Vater. • Double anterior pancreaticoduodenal arcade was observed to arise from the superior pancreaticoduodenal artery in 2%. • Short pancreas was observed in 1%. Interest in pancreatic anatomy has been stimulated by the development of improved clinical imaging modalities (e.g. Ultrasonogram, Computed tomography, Magnetic resonance imaging) and by the growing application of pancreas transplantation to the treatment of diabetes mellitus. This study is presented to shed more light on normal anatomy and variations of the duodenum, the pancreas and the portal vein.

Item Type: Thesis (Masters)
Uncontrolled Keywords: variations, second part of the duodenum, pancreas, portal vein, applied aspects.
Subjects: MEDICAL > Anatomy
Depositing User: Subramani R
Date Deposited: 05 Oct 2019 11:57
Last Modified: 05 Oct 2019 11:57
URI: http://repository-tnmgrmu.ac.in/id/eprint/11695

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