Pancreas

Duodeno-Duodenostomy is also done in treatment of annular pancreas.

A pseudopancreatic cyst is not a true cyst.

It is a chronic collection of pancreatic fluid surrounded by a nonepithelialized wall of granulation tissue and fibrosis. 

It is seen in 10% of patients with acute pancreatitis and 20-30% patients with chronic pancreatitis.

It is the most common complication of chronic pancreatitis.

Pateints usually presents with pain, fullness or early satiety.

Glucagonomas are usually large tumors at diagnosis. 50–80% occur in the pancreatic tail. Insulinoma distributed equally in the head, body and tail. Gastrinoma is usually located at the gastrinoma triangle in the duodenum.

The posterior relations of the head of the pancreas include the common bile duct, inferior vena cava and the right and left renal veins terminating into it. The first part of the duodenum is an anterior relation of the head of the pancreas.

Ans. is ‘a’ i.e., Head

Pancreatic carcinoma

o Pancreatic carcinoma is the most common malignant tumor of pancrease.

Risk factors

• Smoking –> Most consistent risk factor.                

o Obesity                                                                       o High fat, low fibre diet.

o Chronic pancreatitis                                                      o Diabetes

Pathology

o Pancreatic carcinoma are ductal adenocarcinomas.

o Most common site is head of pancrease. The distribution is as follows.

o Head (70%)            

o Body (20%)

o Tail (10%)

Ans. is ‘c’ i.e., Duodenoduodenostomy

“The usual treatment is bypass (duodenoduodenostomy)”- Bailey and Love 25/e p1137

“Retrocolic duodenojejunostomy is the procedure of choice.”- Harrison

“Treatment usually involves bypass, through duodenojejunostomy, rather than resection.”- Sabiston

“The surgical treatment of choice for duodenal obstruction due to duodenal stenosis or atresia or annular pancreas is a duodenoduodenostomy. ^“-Schwartz 9/e

Annular pancreas is a rare condition that results when histologically normal pancreatic tissue completely or partially encircles the second portion of the duodenum.

It is most often seen in association with congenital duodenal stenosis or atresia and is therefore more prevalent in children with Down’s syndrome.

Symptom

– Varying degrees of duodenal obstructive symptoms may be observed in this condition.

– There is bile in the vomitus if the constriction is distal to the entrance of the common bile duct.

• X-ray

–  Dilated stomach and dilated duodenum i.e., (double bubble sign).

• Treatment

– Obstructive symptoms are indication for an operation.

Bypass procedure such as duodenojejunostomy is the t/t of choice. (Note that some books like Bailey and Schwartz mention duodenoduodenostomy as the procedure of choice)

Alternative procedures are :‑

– Duodenoduodenostomy         – Vagotomy

– Gastrojejunostomy              – Bilroth II gastrectomy.

Answer ‘a’ i.e. Complete or partial rotation failure; ‘b’ i.e. Congential ; ‘c’ i.e. Normal histology

Annular pancreas is a congenital anamoly resulting from failure of normal clockwise rotation of the ventral pancreas. The histology of pancreatic tissue is normal.

Posterior surface of neck is related to termination of superior mesenteric vein and its combination with splenic vein to form portal vein.

Ans. is ‘b’ i.e., Origin of portal vein