Abstract
Purpose
Fused pancreatic tissue encasing the portal and/or superior mesenteric vein, circumportal pancreas, is a congenital anomaly that has been associated with operative complications in resections involving the head of the pancreas. We describe this anomaly and highlight its pathophysiology and surgical outcomes through a review of the literature to date, drawings and a computed tomography example.
Methods
A literature search was undertaken using Pubmed and the search terms “circumportal pancreas,” “annular pancreas” and “pancreatic anomaly.”
Results
91 cases of circumportal pancreas were identified in the literature. The number of reported cases increased with time. 14 were documented as having undergone surgery (11 carcinoma or suspected carcinoma/3 benign neoplasm). Surgical outcome was reported in 13. Five of 13 (38.5 %) experienced a fistula. Three cases were treated with a drain. One incident of potentially unnecessary surgery due to the misidentification of circumportal pancreas was noted.
Conclusions
(1) The identification of circumportal pancreas is increasing but is relatively rare. (2) Varying locations of the main pancreatic duct can induce inappropriate construction during pancreaticojejunostomy and can influence the risk of fistula. In the presence of CP, distal pancreatectomy with pancreatic division in front of portal vein creates two sources of pancreatic fistula. (3) The high incidence of associated vascular variants can directly influence pancreatic resection and can affect vascular reconstruction for complete oncologic resection. Therefore, the preoperative location of the main pancreatic duct and presence of any vascular variants in CP must be systematically identified before programed surgery.
Similar content being viewed by others
References
Bret PM, Reinhold C, Taourel P, Guibaud L, Atri M, Barkun AN (1996) Pancreas divisum:evaluation with MR cholangiopancreatography. Radiology 199:99–103
Ferrer J, Scott WE, Weegman BP, Suszynski TM, Sutherland DE, Hering BJ, Papas KK (2008) Pig pancreas anatomy: implications for pancreas procurement, preservation, and islet isolation. Transplantation 86:503–1510
Gonoi W, Akahane M, Akai H, Hagiwara K, Kiryu S, Hayashi N, Ohtomo K (2011) Retroportal main pancreatic duct with circumportal pancreas; Radiographic visualization. Clin Imaging 35:442–446
Hamanaka Y, Evans J, Sagar G, Neoptolemos JP (1997) Complete pancreatic encasement of the proximal hepatic portal vein: a previously undescribed congenital anomaly. BJS 84:785
Harold KL, Sturdevant M, Matthews BD, Mishra G, Heiford BT (2002) Ectopic pancreatic tissue presenting as submucosal gastric mass. J Laparoendosc Adv Surg Tech 12:333–338
Hashimoto Y, Ross AS, Traverso LW (2009) Circumportal pancreas with retroportal main pancreatic duct. Pancreas 38:713–715
Ishigami K, Tajima T, Nishie A, Asayama Y, Kakihara D, Nakayama T, Shirabe K, Taketomi A, Nakamura M, Takahata S, Ito T, Honda H (2011) The prevalence of circumportal pancreas as shown by multidetector-row computed tomography. Insight Imag 2:409–414
Jang J, Chung YE, Kang CM, Choi SH, Hwang HK, Lee WJ (2011) 2 cases of portal annular pancreas. Korean J Gastroenterol 60:52–55
Joseph P, Raju RS, Vyas FL, Eapen A, Sitaram V (2010) Portal annular pancreas. A rare variant and a new classification. JOP J Pancreas 11:453–455
Karasaki H, Mizukami YI, Ishizaki A, Goto J, Yoshikawa D, Kino S, Tokusashi Y, Miyokawa N, Yamada T, Kono T, Kasai S (2009) Portal annular pancreas, a notable pancreatic malformation: frequency, morphology, and implications for pancreatic surgery. Surgery 146:515–518
Kin T, Shapiro A (2009) Circumportal pancreas and islet isolation. Surgery 146:126–127
Koybayashi S, Honda G, Kurata M, Okuda Y, Tsuruta K (2013) Pancreaticoduodenectomy in portal annular pancreas: report of a case. Surg Today 43:926–929
Lecesne R, Stein L, Reinhold C, Bret PM (1998) MR cholangiopancreatography of annular pancreas. J Comput Assist Tomogr 22:85–86
Leyendecker JR, Baginski SG (2008) Complete pancreatic encasement of the portal vein (circumportal pancreas): imaging findings and implications of a rare pancreatic anomaly. J Comput Assist Tomogr 32:61–64
Marjanovic G, Obermaier R, Benz S, Bley T, Juettner E, Hopt UT, Adam U (2007) Complete pancreatic encasement of the portal vein–surgical implications of an extremely rare anomaly. Langenbeck’s archives of surgery/Deutsche Gesellschaft fur Chirurgie 392:489–491
Matsumoto I, Shinzeki M, Fukumoto T, Ku Y (2013) An Extremely rare portal annular pancreas in pancreaticoduodenectomy. Surgery 153:434–436
Morgan DE, Logan K, Baron TH, Koehler RE, Smith JK (1999) Pancreas divisum: implications for diagnostic and therapeutic pancreatography. AJR 173:193–198
Mortele K, Rocha TC, Streeter JL, Taylor AJ (2006) Multimodality imaging of pancreatic and biliary congenital anomalies. RadioGraphics 26:715–731
Muto J, Mano Y, Harada N, Uchiyama H, Yoshizumi T, Taketomi A, Shirabe K, Maehara Y (2012) Additional resection of the pancreas body prevents postoperative pancreas fistula in patients with portal annular pancreas who undergo pancreaticoduodenectomy. Case Rep Gastroenterol 6:131–134
Nijs E, Callaha MJ (2007) Congential and developmental pancreatic anomalies: ultrasound, CT and MRI imaging findings. Sem in US, CT and MRI 28:395–401
Patidar Y, Arora A, Mukund A, Dev A (2012) Portal annular pancreas: an under-reported pancreatic anomaly. J Surg Tech Case Rep 4:140–141
Song S (2008) Complete pancreatic encasement of portal vein: circumportal pancreas. Eur Rad Suppl (abstract) 18:350
Soto JA, Lucey BC, Stuhlfaut JW (2005) Pancreas divisum: depiction with multi-detector row CT. Radiology 235:503–508
Sugiura Y, Shima S, Yonekawa H, Yoshizumi Y, Ohtsuka H, Ogata T (1987) The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery–a case report. Jpn J Surg 17:182–185
Tappouni R, Perumpillichira J, Sakala M, Hosseinzadeh K, Clark C, Leyendecker J (2014) Circumportal pancreas: imaging findings in 40 patients. Abdom Imag [Epublished ahead of Press]
Conflict of interest
All authors have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Connelly, T.M., Sakala, M. & Tappouni, R. Circumportal pancreas: a review of the literature and image findings. Surg Radiol Anat 37, 431–437 (2015). https://doi.org/10.1007/s00276-015-1436-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-015-1436-5