Goel Shivi, Rustagi Shaifaly Madan, Saha Susmita, Mehta Vandana, Suri Rajesh Kumar, Rath Gayatri
Department of Anatomy, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India,
Surg Radiol Anat. 2015 Jul;37(5):543-6. doi: 10.1007/s00276-015-1474-z. Epub 2015 Apr 4.
Anomalous pancreatic ductal system has always enthralled the anatomists, surgeons, gastroenterologists and radiologists alike. With the growing use of MRCP, ERCP and endoscopic and surgical procedures, the knowledge of anatomical aberrations of pancreaticobiliary tract becomes extremely important. Moreover, the anomalous pancreatic duct morphology may be responsible for atypical gastrointestinal complains. We report an exceptionally rare case of two accessory ventral pancreatic ducts opening separately into the common bile duct proximal to the hepato pancreatic ampulla. Concomitant occurrence of an ectopic major duodenal papilla, 3.8 cm distal to the pyloric end of stomach was also seen. Moreover, the accessory pancreatic duct and the minor duodenal papilla were absent. Clinical implications and embryological description of these rare anomalies are discussed. Awareness of such rare morphological variants can go a long way in assisting effective patient management.
异常的胰腺导管系统一直吸引着解剖学家、外科医生、胃肠病学家和放射科医生等。随着磁共振胰胆管造影（MRCP）、内镜逆行胰胆管造影（ERCP）以及内镜和外科手术的日益普及，了解胰胆管的解剖变异变得极为重要。此外，异常的胰腺导管形态可能是导致非典型胃肠道症状的原因。我们报告了一例极为罕见的病例，两条副胰管分别开口于肝胰壶腹近端的胆总管。同时还发现距胃幽门端远端3.8厘米处存在异位主十二指肠乳头。此外，副胰管和小十二指肠乳头缺失。本文讨论了这些罕见异常的临床意义及胚胎学描述。认识到这种罕见的形态变异对有效管理患者大有帮助。
