Download - Dezvoltare Pancreas
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ANATOMIA DEZVOLTARIIANATOMIA DEZVOLTARII
PANCREASULUIPANCREASULUI
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5 weeks
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6 WEEKS
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8 WEEKS
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Fascii coalescen pancreasFascii coalescen pancreas
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Fascii posterioare: Treitz RDP dr+stg (cap),Toldt retromezogastric (corp)
Fascii anterioare: Fredet PDP supra si
submezocolice
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Pancreas - anomalii e e!"ol#arePancreas - anomalii e e!"ol#are
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Pancreas i"is$mPancreas i"is$m
- is the most common congenital anomaly ofthe pancreatic ductal system (4%10% of the
population)
- results when the ventral and dorsalpancreatic ducts fail to fuse
- the ventral duct (duct of Wirsung) drainsonly the ventral pancreatic anlage
- the majority of the gland empties into theminor papilla through the dorsal duct (duct of
antorini)
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!ancreas inelar
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"#ial $$& images in a '-year-old man with annular pancreas"#ial $$& image shows pancreatic tissue (white arrow) completely
encircling the second portion of the duodenum (*lac+ arrow)consistent with an annular pancreas
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Pancreas ec#opicPancreas ec#opic
- 0,%1'% of the population- stomach (,%'.% of cases)/
duodenum (.%',%)/ jejunum(1,%)/ ec+el diverticulum/ ileum
- rarely/ it occurs in the colon/esophagus/ gall*ladder/ *ile ducts/
liver/ spleen/ um*ilicus/ mesentery/mesocolon/ omentum
- usually measures 00 cm inits largest dimension (rarely up to
cm) and is located in thesu*mucosa in appro#imately 0%
of cases- ctopic pancreas in the
gastrointestinal tract is usuallyasymptomatic
- complications such as stenosis/ulceration/ *leeding/ and
intussusception may develop
$& scan o*tained in a patient with a*dominal painshows ectopic pancreatic tissue (arrow) within the
small *owel mesentery
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A%ene!ia& 'ipopla!iaA%ene!ia& 'ipopla!ia- Total agenesisof the pancreas is e#tremely rare/ is incompati*le with life and it is associated
with other malformations such as gall*ladder aplasia/ polysplenia/ and fetal growth retardation- Hypoplasia (partial agenesis)result from the a*sence of the ventral or dorsal anlage- Absence o t!e dorsal anlageis visuali2ed as a short or truncated pancreas and can *e
partial or complete 3t may *e seen as a solitary finding or in association with heterota#iasyndromes
- Partial agenesis o t!e dorsal pancreasis relatively more common than agenesis of theventral portion/ *ut complete agenesis o t!e dorsal pancreasis e#tremely rare
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Anomalii con%eni#ale ( c'is#$riAnomalii con%eni#ale ( c'is#$ri- $ongenital pancreatic cysts are e#ceedingly rare
- &hey have a female predilection- &ypically manifest as an asymptomatic palpa*le mass or patients may also presentwith epigastric pain/ jaundice/ and vomiting related to the compression of surroundingstructures- &hese cysts can *e single or multiple and are most commonly located in the tail and*ody of the pancreas- ultiple congenital cysts are associated with other anomalies/ such as von ippel5indau disease and hepatorenal polycystic disease
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"#ial noncontrast $& shows complete fatty replacement of thepancreas in a 4-year-old man with cystic fi*rosis 6o pancreatic
parenchyma is visi*le in its e#pected location (white outline)
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Anatomie descripti"# pancreas
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PANCREASPANCREAS
CEFALICCEFALIC
aspect anterioraspect anterior
1. pancreatico-1. pancreatico-
duodenala dreaptaduodenala dreapta
superiora,superiora,
gastro-epiploicagastro-epiploica
dreapta,dreapta,colica dreaptacolica dreapta
superioarasuperioara
2. fasciile PP Fredet2. fasciile PP Fredet
supra sisupra si
su!"e#ocolice,su!"e#ocolice,"e#ocolonul"e#ocolonul
trans$erstrans$ers
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PANCREAS CEFALICPANCREAS CEFALIC
aspec# pos#erioraspec# pos#erior
1 planarterial(arcadele
duodeno-pancreatice)/plan ductal(coledoc/pancreatic)/plan venos
(7!) fascia89! &reit2dreapta
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PANCREAS CEFALICPANCREAS CEFALIC
aspec# pos#erioraspec# pos#erior
' 7$3/ vasele renale drepte/ pilierii diafragmului/ 5-5'
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PANCREAS CEFALICPANCREAS CEFALIC
- sup: 91 tu*erculii pre si retro9(cel retro9 ; tu*ercul omental/intraperitoneal)
- dr: 9 ductele pancreatice
- inf: 9' proc
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- !ancreatic head and nec+ lo*ulations are defined as outpouchings of the gland morethan 1 cm *eyond the anterior superior pancreaticoduodenal artery- &hese variations are seen in appro#imately '4% of individuals upon close e#amination
- type 3 (anterior)/ seen in 10% of individuals=- type 33 (posterior)/ seen in 1>%=- type 333 (hori2ontal)/ seen in %- "nother well-recogni2ed pseudomass is a prominence on the anterior surface of thepancreatic *ody to the left of the superior mesenteric vessels that a*uts the posteriorsurface of the lesser omentum &his entity is +nown as tuber omentaleand should *enot misinterpreted as a true pancreatic neoplasm
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- #treme pancreatic lipomatosis can *e seen in cystic fi*rosis and hwachman-9iamondsyndrome/ as well as in dia*etic/ o*ese/ and elderly patients
- type 1a ('% of cases) is characteri2ed *y replacement of the head with sparing of theuncinate process and peri*iliary region=
- type 1* (',%)/ *y replacement of the head/ nec+/ and *ody/ with sparing of the uncinateprocess and peri*iliary region=
- type a (1%)/ *y replacement of the head/ including the uncinate process/ and sparing ofthe peri*iliary region=
- and type * (1.%)/ *y total replacement of the pancreas with sparing of the peri*iliary
region
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)a#$l pancreas$l$i)a#$l pancreas$l$i
*a a an#erioar*a a an#erioar
- intre 1 si $asele "e#enterice superioare- intre 1 si $asele "e#enterice superioare
- fa a anterioar% coresp. Peretelui posterior al &' - raport cu pilorul prin &'- fa a anterioar% coresp. Peretelui posterior al &' - raport cu pilorul prin &'
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- fa a posterioar? raport cu 7 si originea 7! (&reit2 drept- fa a posterioar? raport cu 7 si originea 7! (&reit2 dreptposterior de vase)posterior de vase)
)a#$l pancreas$l$i)a#$l pancreas$l$i
*a a pos#erioar*a a pos#erioar
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Corp$l pancreas$l$i *a a an#erioarCorp$l pancreas$l$i *a a an#erioar
- retroperitoneal- corespundeperetelui posterior al@A
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Corp$l pancreas$l$iCorp$l pancreas$l$i
*a pos#erioar*a pos#erioar
- plan venos: v plenica/ v 3
- fascia &oldt retrome2ogastric
- v renala stanga/ fata ant a rinichiului stang
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Corp$l pancreas$l$iCorp$l pancreas$l$i
- fa a inferioar? me2ocolic? (suprame2ocolic?)- fa a inferioar? me2ocolic? (suprame2ocolic?)
- marginea superioar? trunchi celiac/ ple# solar/ arter? splenic?- marginea superioar? trunchi celiac/ ple# solar/ arter? splenic?
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CoaaCoaa
pancreas$l$ipancreas$l$i
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$oada pancreasului
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!ancreas vasculari2a ie arterial?
1 !9 sup(B9)
!9 inf()
' ! sup(splenica)
4 ! post(splenica)
! inf()
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Pancreas ( "asc$lari!a ie "enoasPancreas ( "asc$lari!a ie "enoas
- !9 sup(B9)
- !9 inf(7)
- vv$orpului(splenicaC
trunchi)
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Pancreas ( lim*a#icePancreas ( lim*a#ice
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Pancreas ( lim*a#icePancreas ( lim*a#ice
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Pancreas ( iner"a iePancreas ( iner"a ie
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%egmentul duodeno&cealic%egmentul duodeno&cealic %egmentul corporeocaudal%egmentul corporeocaudal
- din mugurii pancreatici ventral i- din mugurii pancreatici ventral idorsaldorsal
- din mugurele dorsal/ in grosimea- din mugurele dorsal/ in grosimeame2ogastrului dorsalme2ogastrului dorsal
- fi#at la !!! cu ajutorul fasciilor 89!- fi#at la !!! cu ajutorul fasciilor 89!&reit2&reit2
- corp fi#at la !!! prin &oldt- corp fi#at la !!! prin &oldtretrome2ogastricretrome2ogastric
- coada li*era in epiplonul- coada li*era in epiplonulpancreatico-splenicpancreatico-splenic
- por iuni supra i su*me2ocolica - por iuni supra i su*me2ocolica
- por iunea su*me2ocolica este- por iunea su*me2ocolica esteseparata de inser ia me2enterului Dnseparata de inser ia me2enterului Dnalte por iuni/ dreapta si stangaalte por iuni/ dreapta si stanga
- situat in etjul suprame2ocolic/ la- situat in etjul suprame2ocolic/ lanivelul peretelui posterior al *urseinivelul peretelui posterior al *urseiomentaleomentale
- vasculari2atie hepato-me2enterica- vasculari2atie hepato-me2enterica
superioara (arcadele duodeno-superioara (arcadele duodeno-pancreatice)pancreatice)
- vasculari2atie spleno-me2enterica- vasculari2atie spleno-me2enterica
superioarasuperioara
- e#tirpare in *loc- e#tirpare in *loc(duodenopancreatectomii cefalice)(duodenopancreatectomii cefalice)
- pancreatectomii corporeocaudale- pancreatectomii corporeocaudale(decolare coloepiploica si patrundere(decolare coloepiploica si patrunderein @A)in @A)
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