Prospective observational study on pancreatic duct system diversity in different pancreatic diseases

Abstract

Background: Pancreatology and pancreatic surgery was developed on the basis of increase in knowledge of anatomy and physiology of the pancreas in the beginning of the 20th century. Although our knowledge of pancreatic head anatomy has increased, anatomical data characterizing the pancreatic ductal system remain limited. Furthermore, the relation of pancreatic ductal system anomalies and different pancreatic disorders remain to be evaluated.Methods: The present study was conducted in Department of Paediatric, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar from August 2014 to November 2016. Total 50 subjects were included. Study was done with aim to study cases clinically and segregate cases with pancreatic disorder which need evaluation by special imaging modalities and surgical management, to compare the nature of information obtained from various modalities to study various corollaries of modern imaging study, to study whether the information from various imaging modalities are complimentary, competitive and to study pancreatic ductal structure in different pancreatic diseases.Results: In the present study, we have a total of 50 patients. Among them 25 (50%) suffer from chronic pancreatitis, 13 (26%) from acute pancreatitis, 6 (12%) from periampullary carcinoma, 3 (6%) from carcinoma head of the pancreas, 1 (2%) from pancreatic ascites following acute pancreatitis, 1 (2%) from annular pancreas and 1 (2%) from cystic neoplasm of pancreas. These patients were investigated by transabdominal USG, MDCT scan, ERCP and conventional and stimulated MRCP to study the pancreatic duct diversities in different pancreatic diseases and the advantage of lemon juice stimulated MRCP over conventional MRCP.Conclusions: Pancreatic disorders were most frequently seen in male patients. Age group between 31 to 50 years were mostly suffering from inflammatory disorders like acute and chronic pancreatitis. The frequency of malignant condition was increased after 50 years of age. Most common pancreatic disorder in our study was chronic pancreatitis. Trans-abdominal USG was found to be very useful initial investigation for the evaluation of pancreatic duct morphology. Best investigation for malignant pancreatic condition was MDCT following pancreatic protocol.