Pancreatic division
Introduction
Introduction to pancreatic division Pancreatic division (PD) is a congenital malformation characterized by anastomosis of the main and accessory pancreatic ducts during the development of the pancreas or only a thin branch of the pancreatic duct. It is also called pancreatic separation, pancreatic separation, pancreatic duct Unfused, abnormal pancreatic duct fusion, etc., due to poor drainage of pancreatic juice, it is easy to cause pancreatitis. Asymptomatic people do not need special treatment. The occurrence of the pancreas occurs in the fourth week of human embryo development. Initially, a bud is formed from the dorsal and ventral sides of the foregut, which are called ventralpancreas and dorsalpancreas, respectively. At 7 weeks, the ventral pancreas was metastasized from the ventral side of the duodenum to the dorsal side, which merged with the dorsal pancreas to form a complete pancreas. The ventral pancreas formed most of the pancreatic head, and the dorsal pancreas formed a small part of the pancreatic head and the pancreas and pancreas In the tail, while the dorsal pancreas is fused with the ventral pancreas, the catheters are also fused to each other. The main pancreatic duct (Wirsung tube) is composed of a distal portion of a ventral duct and a dorsal duct, and is open to twelve. Refers to the main nipple of the intestine. Most of the pancreatic juice is drained to the duodenum through the main nipple. The proximal part of the dorsal pancreatic duct gradually degenerates or even disappears. If it remains, it is called the parasitic pancreatic duct (santorini tube). The pancreatic juice, which opens in the duodenal nipple, if the embryo develops in the middle of the fetus 7 weeks ago, the back and abdomen pancreatic duct fail to fuse or only the thin branch pancreatic duct anastomosis, the main pancreatic duct can only Drains the pancreatic juice secreted by the ventral pancreas, while the accessory pancreatic duct becomes the pancreas The main drainage pipe, responsible for drainage of pancreatic body and tail of the pancreatic juice, this anomaly is the PD. basic knowledge The proportion of illness: rare, the incidence rate of alcoholics is about 0.1% - 0.3% Susceptible people: no special people Mode of infection: non-infectious Complications: abdominal pain, pancreatitis
Cause
Pancreatic schizophrenia
Causes of pancreatic division (30%):
The disease is a congenital malformation characterized by an anastomosis of the pancreas during development, and the accessory pancreatic duct is completely unfused or only a thin branch of the pancreatic duct.
Pathogenesis (30%):
The pancreas occurs at the 4th week of human embryonic development, initially extending a bud from the dorsal and ventral sides of the foregut, called ventral pancreas and dorsal pancreas, with embryonic development. By the 7th week, the ventral pancreas was metastasized from the ventral side of the duodenum to the dorsal side, and merged with the dorsal pancreas to form a complete pancreas. The ventral pancreas forms the majority of the pancreatic head, and the dorsal pancreas forms a small part of the pancreatic head and the pancreas. And the tail of the pancreas, the fusion of the dorsal pancreas and the ventral pancreas, the catheter also merges with each other, the main pancreatic duct (Wirsung tube) is formed by the ventral duct and the distal part of the dorsal duct, and Opening in the main nipple of the duodenum, most of the pancreatic juice is drained to the duodenum through the main nipple, and the proximal part of the dorsal pancreatic duct gradually degenerates or even disappears. If it remains, it is called the parasitic pancreatic duct (santorini tube). Drain a small part of the pancreatic juice, which opens in the duodenal nipple. If the embryo develops in the middle of the fetus 7 weeks ago, the back and abdomen pancreatic ducts fail to fuse or only the thin branches of the pancreatic duct are anastomosed. The pancreatic duct can only drain the pancreatic juice secreted by the ventral pancreas, while the accessory pancreatic duct becomes the pancreas. The main drainage tube of the gland is responsible for draining the pancreatic body and the pancreatic juice in the tail. This abnormality is PD.
Because the opening of the secondary nipple is too small, the accessory pancreatic duct is too thin or narrow, it is easy to drain the pancreatic juice, and all or most of the pancreatic juice is excreted by the accessory pancreatic duct. It is easy to be restricted by the nipple during the peak of pancreatic secretion. Elevated pancreatic duct pressure, resulting in acinar rupture into a cystic cavity, resulting in intractable abdominal pain or pancreatitis, Eisen has reported 4 cases of sub-pancreatic duct head cavity formation.
Prevention
Pancreatic division prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
1. Adjust daily life and workload, and regularly carry out activities and exercise to avoid fatigue.
2. Maintain emotional stability and avoid emotional excitement and tension. Diet should be light, eat more fruits and high-fiber foods.
Complication
Pancreatic divisional complications Complications abdominal pain pancreatitis
There is a stenosis at the opening of the nipple, and obstructive abdominal pain and pancreatitis occur when the drainage is poor.
Symptom
Symptoms of pancreatic division Common symptoms Abdominal pain Abdominal tenderness Chronic abdominal pain
PD is a congenital anatomic abnormality. Some patients may have no clinical symptoms, only stenosis at the opening of the nipple, obstructive abdominal pain when drainage is poor, pancreatitis or both, Lehman et al report 52 cases PD patients, including 24 cases of refractory abdominal pain (46%), 17 cases of acute recurrent pancreatitis (32.7%), 11 cases of chronic pancreatitis (21.1%), Warshaw et al reported 100 cases of paroxysmal acute pancreatitis and pancreatic Among the patients with abdominal pain, 71 cases were typical PD, Li Zhaoshen et al reported 10 cases of abdominal pain, and 5 cases had a history of recurrent pancreatitis.
Examine
Pancreatic division check
1. ERC: ERCP, intubation from the main nipple, showing the ventral pancreatic duct, showing short, and on the right side of the spine, dendritic or horsetail-shaped branches, showing no accessory pancreatic duct, intubation from the vice papilla As can be seen, the main main pancreatic duct, directly to the tail of the pancreas, the dorsal pancreatic duct and the ventral pancreatic duct do not communicate or only a small traffic branch anastomosis, Warshaw et al.
Technical attention should be paid to the following points in the technique of secondary nipple catheterization:
(1) It is difficult to intubate with a conventional contrast catheter, and a fine contrast catheter should be used.
(2) It is easier to successfully use the push-type mirror.
(3) Once developed, take a quick shot.
The ERCP examination will inflate and pain after injecting the contrast agent, and the distal end of the PD can not be displayed. The dorsal pancreatic duct of the PD is open to the duodenal nipple. If the catheter is not successfully inserted into the pancreatic duct opening, the pancreatic duct cannot be displayed.
2. Magnetic resonance cholangiopancreatography (MRCP): The principle of water imaging can be used to show the pancreaticobiliary duct. The pancreatic division can be displayed on the ventral pancreatic duct and the dorsal pancreatic duct. The pancreatic duct is a short lumen, which is open to the duodenal papilla. It can be opened together with the common bile duct. It can also be opened separately. MRCP is non-invasive, no radiation radiation, and the patient has no pain. It is simple and convenient. Many scholars have suggested that MRCP examination using pancreatic secretion can improve the imaging quality and diagnosis rate of MRCP.
3. Other imaging examinations: CT and B-ultrasound can show pancreatic enlargement or catheter dilatation, but can not diagnose pancreatic schizophrenia.
Diagnosis
Diagnosis and differentiation of pancreatic division
Diagnostic criteria
Mainly diagnosed according to ERCP or MRCP, the ERCP diagnostic criteria proposed by Jinquan et al are as follows:
1. Diagnosis: Tumor angiography from the main nipple, the ventral pancreatic duct was short, and the dorsal pancreatic duct was developed from the accessory nipple catheter, but the dorsal and abdominal pancreatic ducts had no communication anastomosis.
2. Basic diagnosis: only the dorsal pancreatic duct is developed from the side of the nipple.
3. Suspicious diagnosis: Intubation from the main nipple, only the short ventral pancreatic duct.
Differential diagnosis
1. Pancreatic cancer: The pancreatic duct morphology of PD patients is not like pancreatic cancer with irregular stenosis or interruption, which is the main image identification point of pancreatic cancer.
2. Loss of the tail of the pancreas: The end of the paracentral pancreatic duct can be used to exclude PD. The CT and B-ultrasound can show the loss of the tail of the pancreas.
3. Chronic pancreatitis: The steatosis of the body may occur in the tail of chronic pancreatitis. The main pancreas is thinned and sometimes looks like an unfused ventral pancreatic duct. After filling the angiography, the accessory pancreatic duct is excluded from PD. Chronic pancreatitis may be Confirmed by other images.
