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Aim. To assess the results of distal pancreatectomy for malignant and benign tumors and chronic pancreatitis complications. Materials and methods. Forty-seven patients, who underwent distal pancreatectomy, were under observation during the period from 01.01.2008 to 28.02.2019. Results. The long-term results of surgical treatment demonstrated the following complications: pancreatic fistulas – 15 % of observations, pancreatogenic diabetes mellitus – 12.7 %, subphrenic abscesses – 10 %. In the long-term period after the surgery – from 10 years and not less than one year – 30 patients were followed up, constituting 63.8 % of the total number. Conclusions. To prevent complications in the form of pancreatic fistula with pathological Wirsung duct dilatation more than 4–5 mm in diameter, it is necessary to form anastomosis between the pancreatic stump and the small bowel.

Background The European Consensus 2018 established a new algorithm with absolute and relative criteria for intraductal papillary mucinous neoplasms of the pancreas (IPMN) management. The aim of this study was to validate these criteria and analyse the outcomes in function of the surgical procedure and IPMN subtype. Methods Clinical, radiological and surgical data (procedure, morbidity/mortality rates) of patients who underwent surgery for IPMN between 2007 and 2017. The predictive value of the different criteria was analysed. Results 124 patients (men 67%; mean age 65 years) underwent surgery for IPMN (n = 62 malignant tumours; 50%). Jaundice, cyst ≥4 cm and Wirsung duct size 5–9.9 mm or ≥ 10 mm were significantly associated with malignancy (4.77

Background: Pancreatoduodenectomy (PD) is a complex procedure with a relatively high risk of complications. There is an increasing trend showing that the success of pancreato-enteral anastomosis depends on surgical skill and the material used. Methods: We present four cases of pancreato-enteral anastomosis resected 37 - 114 days after primary surgery and the analysis of the healing process, i.e., morphology of the pancreatic parenchyma, pancreatic duct, and digestive tract mucosa, as well as the pancreatic reaction to the sewing material by microscopic morphometry. Results: Evidence of regeneration in the columnar-lined mucosa of main pancreatic ducts in all cases of pancreato-enterostomy was observed. The inflammatory foreign-body reaction around monofilament stitch was present without an evident infection. There were no microscopic signs of pancreatic duct damage. Total foreign body reaction varied between 138.1 μm and 207.3 μm. Conclusions: This observation supports the beneficial use of thin monofilament threads for pancreato-enteral anastomosis. There was no evidence of harmful action from gastric or intestinal juices on pancreatic remnant or the Wirsung duct.

Objectives Several hypotheses have been proposed to explain the embryogenesis of an annular pancreas. Three-dimensional (3D) imaging of the annular pancreas may be useful to elucidate the embryogenesis. The aim of this case report is to clarify the pancreatic ducts in the annular pancreas by 3D computed tomography pancreatography (3D-CTP), stereographically. Methods Three-dimensional CTP under endoscopic retrograde pancreatography using a balloon catheter was performed with a helical CT scanner. Three-dimensional images of the pancreatic duct were obtained with simple threshold, shaped surface display. Results Wirsung duct that surrounds the ventral side of the descending portion of the duodenum and Santorini duct that surrounds the dorsal side of the descending portion of the duodenum were reconstructed by 3D-CTP, stereographically, and the presence of an annular pancreas was confirmed. These findings suggest that the formation of the annular pancreas in the current case may be attributable not only to abnormal development of the right lobe of the ventral pancreatic bud, but also to overgrowth of the dorsal pancreatic bud toward the ventral aspect of the duodenum or excessive rotation of the duodenum following fusion of the ventral bud to the dorsal bud. Conclusion Three-dimensional CTP is expected to contribute usefully toward clarifying the embryogenesis of an annular pancreas.

The aims of this study were to identify the morphological diversities and anatomical variations of pancreatic ductal system and to define the relationships between pancreatic ductal systems, pancreaticobiliary diseases, and procedure- related complications, including post-ERCP pancreatitis. This study included 582 patients in whom both pancreatic duct (PD) and common bile duct were clearly visible by ERCP. PD systems were categorized into four types according to the relationship between common bile duct and PD. In types A and B, Wirsung duct formed the main PD. In type C, Wirsung duct did not form the main PD. If PD system did not fall into any of these three types, it was categorized as type D. The distribution of types among pancreatic ducts examined was as follows: type A: 491 cases (84.4%), type B: 56 cases (9.6%), type C: 20 cases (3.4%), and type D: 15 cases (2.6%). The anomalous anatomic variations of PD systems were divided into migration, fusion, and duplication anomalies. PD anomalies were noted in 51 patients, of which 19 (3.3%) were fusion anomalies (12 complete pancreas divisum, 7 incomplete pancreas divisum), and 32 (5.5%) were duplication anomalies (5 number variations, 27 form variations). No significant relationships between various PD morphologies and pancreaticobiliary diseases were found. However, post- ERCP hyperamylasemia was more frequently found in types C (41.7%), D (50%) and A (19.8%) than in type B (9.4%). In summary, whether Wirsung duct forms the main PD and the presence or absence of the opening of the Santorini duct are both important factors in determining the development of pancreatitis and hyperamylasemia after ERCP.

We describe a rare case of fistula between the Wirsung duct and the right psoas muscle. The initial clinical presentation was localised in the thigh and successful treatment was achieved by exclusive mini-invasive techniques.

We read with great interest the article by Fisher and colleagues concerning the importance of the disconnected Wirsung duct syndrome in pancreatic diseases. Here we discuss the value of this radiologic sign, which today must be considered on CT or MRI images when staging the severity of acute pancreatitis and evaluating its possible evolution. We reviewed a series of 20 patients, aged between 35 and 72 years, 12 females and 8 males, who were admitted for severe pancreatitis in the years 201

To the Editor:The human exocrine pancreas develops embryologically from the ventral and the dorsal anlagen that evaginate from the primitive foregut during the fifth week of gestation. The dorsal anlage will form the superior part of the head, the body, and the tail of the pancreas, whereas the vent

[1] Rajnakova A, Mutignani M, Costamagna G. Wirsung duct duplication. Pancreas 2010;39:266–8. [2] Chang YT, Chang MC, Wong JM. Education and imaging. Hepatobiliary and pancreatic: duplication of the main pancreatic duct in the head of pancreas. J Gastroenterol Hepatol 2008;23:337. [3] Uomo G, Manes G, D’Anna L, Laccetti M, Di Gaeta S, Rabitti PG. Fusion and duplication variants of pancreatic duct system. Clinical and pancreatographic evaluation. International Journal of Pancreatology 1995;17:23–8.

Chronic nonpathological pancreatic hyperenzymemia (CNPH) is a new syndrome characterized by an increase in serum pancreatic enzymes in the absence of pancreatic disease. The aim of this study was to increase our understanding of this condition by determining the serum pancreatic enzyme response as well as changes in the caliber of the Wirsung duct after secretin stimulation.Twenty subjects with CNPH and 9 healthy subjects without CNPH were studied. Blood samples were drawn 5 and 0 min before and 5, 10, 15, 30, 45, and 60 min after intravenous injection of secretin (1 U/kg). Amylase, pancreatic isoamylase, and lipase concentrations were determined. The caliber of the Wirsung duct was measured by ultrasonography.The injection of secretin caused a marked and statistically significant (p0.05) increase in serum pancreatic enzymes in the subjects with CNPH that persisted for the duration of the study. The increase over the basal value was in the range of 1.2- to 1.6-fold for amylase, 1.4- to 2.1-fold for pancreatic isoamylase, and 2.6- to 4.2-fold for lipase. In the control subjects the increase was mild, but statistically significant (p0.05), ranging from 1.1- to 1.2-fold for amylase, 1.2- to 1.4-fold for pancreatic isoamylase, and 1.5- to 2.2-fold for lipase. The injection of secretin caused a slight increase in the diameter of the Wirsung duct in both groups of subjects, but this was statistically significant only during the first 30 min of the study.The serum pancreatic enzyme response to secretin was more marked in CNPH than in controls. The Wirsung duct showed no alterations after secretin injection that would help to explain the hyperenzymemia.

Per duodenoscopic cannulation of the biliopancreatic ducts has allowed for a new approach to the area of Vater’s ampulla and oddi sphineter.

In our laboratory in Marseille we have approached the problem of the isolation and characterization of human pancreatic proteins by focusing our attention on zymogens present in pancreatic juice [1, 2, 3]. In this way, we could bypass many of the problems associated with the presence of fat and nucleic acids in tissue and also the uncontrolled activation of the zymogens usually found in post-mortem tissue. Human pancreatic juice is collected by cannulation of the Wirsung duct. It is devoid of free trypsin activity.

A case of primitive carcinoid tumor of the Wirsung duct detected by fiberoptic guided brushing cytology is reported. The authors describe the main cytomorphologic characteristics and underline the role of immunocytochemistry in helping to reach a reliable preoperative diagnosis.

It was studied, by dissection, the pancreatic duct system in 30 thoroughbred equines (15 males and 15 females) adults. The results obtained show that the main duct (Wirsung's) proceeds from the union of two roots, the collectors of the right and left lobes and receives, as well as its roots, varied number of affluents, respectively : four (13.3%), six (13.3%), seven (13.3%), one (10.0%), eight (6.7%), nine (6.7%), ten (6.7%), thirteen (6.7%), sixteen (6.7%), two (3.3%), three (3.3%), five (3.3%), eighteen (3.3%) and twenty (3.3%); eight (16.7%), ten (13.3%), eleven (10.0%), thirteen (10.0%), twenty one (10.0%), twelve (6.7%), eighteen (6.7%), four (3.3%), six (3.3%), nine (3.3%), fourteen (3.3%), fifteen (3.3%), twenty (3.3%), twenty three (3.3%) and twenty four (3.3%); sixteen (16.7%), eighteen (10.0%), twenty four (10.0%), fourteen (6.7%), twenty eight (6.7%), thirty one (6.7%), twelve (3.3%), seventeen (3.3%), nineteen (3.3%), twenty (3.3%), twenty one (3.3%), twenty two (3.3%), twenty six (3.3%), thirty (3.3%), thirty two (3.3%), thirty three (3.3%), thirty four (3.3%), thirty seven (3.3%), thirty eight (3.3%), thirty nine (3.3%). A secondary system is composed by the Santorini duct which reaches, almost always, (76.7%) the lesser duodenal papilla and opens, by its central extremity, directly in the Wirsung duct (70.0%), in the duct of the left lobe (13.3%) or in the duct of the right lobe (10.0%). It receives, several afferents in its trajectory , that is: five (16.7%), four (13,3%), eight (10,0%), nine (10.0%), three (6.7%), six (6.7%), seven (6.7%), two (3.3%), eleven (3.3%), twelve (3.3%), fourteen (3.3%), fifteen (3.3%), sixteen (3.3%), nineteen (3.3%) and twenty two (3.3%). Anastomosis were seen communicating diverses collectors of the pancreatic duct system, in a good deal of glands (66.7%) Normal 0 21 false false false PT-BR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabela normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-fareast-language:EN-US;}