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Pancreatic ducts

The pancreatic ductal embryology is moderately complicated, leading to a number of anatomical variants of the pancreatic ducts, many of which are clinically significant.

The normal arrangement is for the entire pancreas to be drained via a single duct, to the ampulla of Vater through the sphincter of Oddi.

Conventional pancreatic ductal anatomy

Main pancreatic duct
  • portion of the dorsal duct proximal to the dorsal-ventral fusion point
  • drains at the ampulla of Vater
  • connects with the duct of Santorini (see below) if present
Pancreatic duct of Wirsung
  • segment of the ventral duct between the dorsal-ventral fusion point and the major papilla
Accessory pancreatic duct (of Santorini)
  • portion of the dorsal duct distal to the dorsal-ventral fusion point 
  • drains anterior and superior portion of the head
    • in 70% of individuals drains at the minor papilla
    • in 30% of individuals persists as a branch of the main pancreatic duct

Variant anatomy

Variants of the pancreas, which result in ductal variations are covered in the pancreas article. 

Pancreas divisum

pancreas divisum is the most common variation of pancreatic duct formation and can account for up to 14% 3. It results from failure of fusion of dorsal and ventral pancreatic anlages. As a result, the dorsal pancreatic duct drains most of the pancreatic glandular parenchyma via the minor papilla. Although controversial, this variant is considered as a cause of  pancreatitis 1,3

Pancreatic divisum can result in a santorinicele 2, which is a cystic dilatation of the distal dorsal duct, immediately proximal to the minor papilla . 

Three subtypes are known 5:

  • type 1 - classic: no connection at all; occurs in the majority of cases (~70%)
  • type 2 - absent ventral duct: minor papilla drain all of pancreas while major papilla drains bile duct (~25%)
  • type 3 - functional: filamentous or inadequate connection between dorsal and ventral ducts (~5%)
Meandering main pancreatic duct

Meandering main pancreatic duct (MMPD) comprises of a reverse Z-type and loop-type of pancreatic ducts.

Ansa pancreatica

Ansa pancreatica is a rare anatomic variation of the pancreatic ducts. It is a communication between the main pancreatic duct and the accessory pancreatic duct.

Anomalous pancreaticobiliary junction

Anomalous pancreaticobiliary junction refers to the union of the pancreatic duct and common bile duct outside the duodenal wall. 

Etymology

The duct of Wirsung was first reported in an etching by Johann Georg Wirsung (1589-1643), a German-Italian anatomist 8.  

The accessory pancreatic duct of Santorini is named after Giovanni Domenico Santorini (1681-1737), an Italian professor of medicine 8


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