A, A branch-duct IPMN with extension into and dilation of the side and main pancreatic ducts
Specific indications that have been proposed for pancreaticoduodenectomy for trauma are: (i) extensive devitalisation of the head of the pancreas and duodenum so that reconstruction is not possible, (ii) ductal disruption of the pancreatic head in association with injuries to the duodenum and distal common bile duct, (iii) injury to the ampulla of Vater, with disruption of the main pancreatic duct
from the duodenum, (iv) uncontrollable bleeding from vessels in the head of the pancreas, and (v) inaccessible exsanguinating retropancreatic portal or superior mesenteric vein injury.
While endoscopic treatment provides inferior results to surgery for long-term pain control in uncomplicated CP, it would seem reasonable to offer this less invasive, but technically-demanding treatment option, in the small sub-group of patients with localised strictures and stones in the main pancreatic duct
Intraductal papillary mucinous neoplasms (IPMN) may involve the main pancreatic duct
exclusively, a side-branch or both.
Many pseudocysts demonstrate communication with the main pancreatic duct
, best seen with either ERCP or MRCP.
Pseudocyst communication with the main pancreatic duct
was present in 2, a cut-off of the main pancreatic duct
in 5, and no connection demonstrated with the pseudocyst in 1.
The most characteristic imaging feature is the communication of the lesion with the main pancreatic duct
, which differentiates them from mucinous cystic neoplasms.
29,30) Stenting via ERCP over the main pancreatic duct
injury or transection or simply over the sphincter of Oddi in order to decrease transpapillary pressure are therapeutic options.
IPMN are characterized by dilation of the main pancreatic duct
, intraluminal filling defects, and associated clusters of smaller cyst-like structures.
15) Motosugi et al (16) described a 2-tone duct sign in ITPNs on the dynamic CT (7 of 10, 70%) and MR images (5 of 8, 63%), with a slightly higher density area representing the tumor in the main pancreatic duct
and a lower density area representing dilated upstream duct.
The portion of the dorsal duct upstream to the dorsal-ventral fusion point is called the main pancreatic duct
Intraoperative ultrasound is helpful in localizing small tumors and delineating their relationship to the main pancreatic duct
and adjacent vessels (Figure 6).