Pancreatoduodenal Junction: Review of Anatomy and Pathologic Conditions

Introduction The pancreatoduodenal junction is a small anatomic area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla de Vater, and retroperitoneum converge. Differential diagnosis includes a spectrum of entities that ranges from anatomical variants to ma...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2011-07, Vol.15 (7), p.1269-1281
Main Authors: Hernandez-Jover, Diana, Pernas, Juan Carlos, Gonzalez-Ceballos, Silvia, Lupu, Ion, Monill, Josep Maria, Pérez, Carmen
Format: Article
Language:English
Subjects:
Abdomen
Ampulla of Vater - anatomy & histology
Bile ducts
Cancer
Common Bile Duct Diseases - diagnosis
Cysts
Diagnostic Imaging - methods
Duodenal Diseases - diagnosis
Duodenum - anatomy & histology
Gastroenterology
GI Image
Hematoma
Humans
Iatrogenesis
Medicine
Medicine & Public Health
Pancreas
Pancreas - anatomy & histology
Pancreatic Diseases - diagnosis
Pancreatitis
Pseudoaneurysm
Small intestine
Surgery
Tomography
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Summary:Introduction The pancreatoduodenal junction is a small anatomic area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla de Vater, and retroperitoneum converge. Differential diagnosis includes a spectrum of entities that ranges from anatomical variants to malignancies. Purpose The aim of this paper was to review the anatomy and different pathologic conditions, whether tumoral, inflammatory, or congenital in origin, in this specific area that involves the pancreatic head, duodenum, duodenal ampulla, distal pancreatobiliary tract junction, and retroperitoneum. Methods Computed tomography (CT) and magnetic resonance (MR) help us to identify specific radiologic signs that allow to divide the pancreatic-duodenal junction abnormalities into three cathegories: (1) normal variants and congenital anomalies (pancreas divisum, santorinicele, annular pancreas,duodenal duplication cyst, choledocal cyst,...); (2) acquired non-tumoral: traumatic, iatrogenic, inflammatory (duodenal hematoma, duodenal iatrogenic perforation, groove pancreatitis, gastroduodenal artery pseudoaneurysm,...); (3) tumoral (pancreatic head adenocarcinoma, periampullary tumors, neuroendocrine pancreatic tumors, duodenal adenocarcinoma,...). The images illustrate morphologic aspects of these entities. Results and Conclusions CT and MR are the most appropiate imaging modalities to evaluate pancreatoduodenal junction. Knowing the imaging features is crucial to reach the right diagnosis and treatment of the different entities that involve this anatomic area.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-011-1443-8