Authors : Uko Ogba

Volume/Issue : Volume 9 - 2024, Issue 5 - May

Google Scholar : https://tinyurl.com/4ywbtb9x

Scribd : https://tinyurl.com/2veap5jw

DOI : https://doi.org/10.38124/ijisrt/IJISRT24MAY2154

Abstract : The pancreatic duct is an intrapancreatic restricted tube that connects the pancreas to the common bile duct. The pancreatic duct transports pancreatic juice to the common bile duct for digesting. Pancreatic duct diameter is an important index in assessing pancreatic duct pathology as well as the pancreas. Duct obstruction may lead to dilatation due to cancer of the pancreas, pancreatitis, cholelithiasis or duodenal pathology. Recent studies have established a direct relationship between dilatation of the pancreatic duct and cancer of the pancreas. The objective of this study is to determine the pancreatic duct diameter in apparently healthy individuals in Gaborone and its relationship with anthropometric variables. Sonographic determination of the pancreatic duct diameter is very important for providing an objective evaluation of the pancreas and the nature and extent of disease if pathologic. Establishment of a baseline reference value for the pancreatic duct diameter is therefore important for providing a normogram in healthy individuals in Gaborone, Botswana. A total of 384 randomly selected individuals and 330 pancreatic duct diameter measurements were used for the study between July 2020 and May 2021. Optimum sonographic scanning technique described by Taylor et al was utilized in measuring the pancreatic duct diameter in this study. The mean pancreatic duct diameter was: 2.40±0.58mm for the head, 2.10±0.50mm for the body and 1.84±0.54mm for the tail. The mean pancreatic duct diameter for the present study was 2.11±0.50mm. The pancreatic duct diameter increased with age from 45years, indicating statistically significant relationship (P-value=0.0492). There was no significant statistical difference in the overall mean pancreatic duct diameter between male and female (p > 0.05). The present study has established that the pancreatic duct diameter for adults in Gaborone is 2.11±0.50mm and could be used in clinical setting as baseline reference value. The normogram also will be a valuable tool in age related pancreatic duct pathologies.

Keywords : Pancreatic Duct Diameter, Sonographic Determination.

References :

1. Ana, C. N. (2019). The exocrine pancreas is an extracardiac source of atrial natriuretic peptide.European journal of Physiology 471(6), 915-924.
2. Anakwue A.C, Ugwu A.C, Nwogu U.B, Idigo F.U.& Agwu K.K. (2009) Sonographic evaluation of normal portal vein diameter in Nigerians. European Journal of Scientific Research 36: 114-7.
3. Andres R. Ayoob , James T. Lee, Keith Herr, Christina A. LeBedis, Ashwin Jain, Jorge A. Soto, Jihoon Lim, Gayatri Joshi, Joseph Graves, Carrie Hoff, Tarek N. Hanna (2021) Pancreatic Trauma: Imaging Review and Management Update. Radiographics 41: 5-7.
4. Bayes, Thomas (1763).’’An Essay towards solving a problem in the Doctrine of chances “. Philosophical Transactions.53, 370-418. Doi: 10.1098/rstl.1763.0053.S2CID 186213794.
5. Belete T. M. (2020) A Recent Achievement in the Discovery and Development of Novel Targets for the Treatment of Type-2 Diabetes Mellitus Journal of experimental pharmacology 12: 1–15. doi: 10.2147/JEP.S226113
6. Bertin C, Pelletier AL, Vullierme MP (2012) Pancreas divisum is not a cause of pancreatitis by itself but acts as a partner of genetic mutations. American Journal of Gastroenterology. 107:311–317.
7. Bülow R, Simon P, Thiel R, Thamm P, Messner P, Lerch MM (2014) Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population. European Journal of Radiology.24:3142–3149.
8. Cesare Berra, Francesco De Fazio, Elena Azzolini, Marco Albini, Federico Zangrandi, Marco Mirani, Stefania Garbossa, Rodolfo Guardado-Mendoza, Gianluigi Condorelli & Franco Folli. (2019) Hypoglycemia and hyperglycemia are risk factors for falls in the hospital population. Acta Diabetol 56, 931–938, https://doi.org/10.1007/s00592-019-01323-8
9. Chao H C, Lin S J, Kong M S Luo C C (2000) Sonographic evaluation of the pancreatic duct in normal children and children with pancreatitis Journal of ultrasound in medicine. 19(11), 757-763   https://doi.org/10.7863/jum.19.11.757
10. Chen, Jiann-Hwa (2018) Role of Endoscopic Ultrasonography in the Management of Benign Biliopancreatic Diseases. Journal of Biliopancreatic Endoscopy. 19(3), 243-250.
11. Chera S, Baronnier D, Ghila L, Cigliola V, Jensen J.N, Gu G, Furuyama K, Thorel F, Gribble F.M, Reimann F (2014). Diabetes recovery by age-dependent conversion of pancreatic delta-cells into insulin producers Nature Journal.514(7523), 503–507.
12. Covantev S, Mazuruc N, and Belic O (2019) The Arterial Supply of the Distal Part of the Pancreas. Journal of surgery, research and practice. 2(1), 5.
13. Daradkeh S, Tarawneh E., Al-Hadidy A (2015) Factors affecting common bile duct diameter. Hepatogastrology 52(66):1659-61.
14. Funabiki T, Matsubara T, Miyakawa S, and Ishihara S (2009) Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy Langenbeck's Archives of Surgery, 394(1) 159–169.
15. Fusco, G. (2019). Shackelford's Surgery of the Alimentary Tract 2nd Volume 8^th Edition Saunders Co Ltd, London, United Kingdom. Pages 90-100
16. Glaser J, Hogemann B, Krummenerl T, Schneider M, Hultsch E, Van Husen N & Gerlach U (2007) Sonographic imaging of the pancreatic duct: New diagnostic possibilities using secretin stimulation. Digestive Disease & Sciences Journal 32(10):1075-1081.
17. Glaser J.  Stienecker K. (2000) Pancreas and Aging: A Study Using Ultrasonography Gerontology 46(2):93–96 https://doi.org/10.1159/000022141
18. Gyanprakash A. Ketwaroo, David Y. Graham (2019) Rational Use of Pancreatic Enzymes for Pancreatic Insufficiency and Pancreatic Pain Journal of advances in Experimental Medicine and Biology 1148(1):323-343
19. Hadidi, A., (2013). Pancreatic duct diameter: Sonographic measurement in normal subjects. Journal of Clinical Ultrasound 11(1):17-22.
20. Henry, G. (2021). Gray's Anatomy: The Anatomical Basis of Clinical Practice. (42nd ed.). (S. Standring, Ed.) London: Churchill Livingstone Elsevier. ISBN 978-0-443-06684-9. Page 810-832.
21. Joseph Fusco, Yousef El-Gohary, George K. Gittes (2019) Anatomy, Physiology, and Embryology of the Pancreas15th ed, Volume 2 (5): 1062-1075.
22. Julienne K.K and Jane Stegner (2010) Self-Monitoring of Blood Glucose: Practical Aspects Journal of Diabetes Science and technology 4:(2) 435-439 https://doi.org/10.1177/193229681000400225.
23. Kochhar N G, Shabna C (2017) Variations in the duct system of pancreas: A cadaveric study. International journal of Anatres ;5(3.1):4136-4143.
24. Lalchhandami Colney, Nikhil Tandon, Pramod Kumar Garg, Nandita Gupta, Sushma Sagar, Amit Gupta, Atin Kumar & Subodh Kumar. (2021) Exocrine and endocrine functions and pancreatic volume in patients with pancreatic trauma. European Journal on Trauma & Emergency Surgery. https://doi.org/10.1007/s00068-021-01638-8.
25. Laura W. Lamps and Sanjay Kakar (2017) Diagnostic Pathology: Hepatobiliary and Pancreas 3rd edition Volume 1, Pages 366-374 Elsevier Inc., Amsterdam, Netherlands. 9780323443234.
26. Lucas N. Pina, Leonardo Abramson, Franca S. Samoilovich, Agustín Rodriguez, Débora C. Knaus, María L. Tartaglia, Dario S. Novelli and Luis A.C. Lopolito (2013) The pancreatic ductal system and biliaropancreatic union: a study of 50 cases European journal of Anatomy 17(4) 193-201.
27. Lucas N. P (2016) Does the Accessory Pancreatic Duct have any Protective Role in Acute Biliary Pancreatitis? Anatomical Findings from Cadaver Dissections. MOJ Anatomy& Physiology, 2(7): 00071.
28. Maccioni F, Martinelli M, Al Ansari N (2010). Magnetic resonance cholangiography: past, present, and future: a review. Eur Rev Med Pharmacol Sci, 14 (8): 721-5.
29. Malathi K, Kishan Reddy C (2019) The study of anatomy of main pancreatic duct and its variations. Perspectives in Medical Research; 7(2):31-37.
30. Mark A. Atkinson, Martha Campbell-Thompson, Irina Kusmartseva & Klaus H. Kaestner (2020) Organization of the human pancreas in health and in diabetes.Diabetologia 63, 1966–1973. https://doi.org/10.1007/s00125-020-05203-7
31. Michael J Darby, Dominic A Barron, Rachel E Hyland (2012) Oxford handbook of Medical Imaging, 7^thEdition, Pg:341-357.
32. Mortelé KJ, Rocha TC, Streeter JL et-al. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics. 2006; 26 (3): 715-31.
33. Olowoyeye O.A, Arogundade R.A, and Awosanya G.O.G (2007). Ultrasonic Dimensions of Normal Pancreatic Duct in Healthy Nigerians West African Journal of Ultrasound. 196(45).48-59.
34. Onder H, Ozdemir MS, Tekbas G, Ekici F, Gümüs F, Bilici A (2013). 3-T MRI of the biliary tract variations Journal of Surgical and Radiological Anatomy. 35:161–7.
35. Paul M, Hobbs, William G. Johnson, David Y. Graham (2016) Management of pain in chronic pancreatitis with emphasis on exogenous pancreatic enzymes. World Journal of Gastrointestinal Pharmacology and Therapeutics 7(3):370–386.
36. Perret R.S., Sloop G.D., & Borne J.A. (2010) Common bile duct measurement in an elderly population Journal of Ultrasound in Medicine 19:727-730.
37. Riccardo Manfredi, Roberto Pozzi Mucelli (2013) Magnetic Resonance Cholangiopancreatography (MRCP): Biliary and Pancreatic Ducts. Pg. 20-30.
38. Ryan M Juza, Eric M. Pauli (2019) Endoscopic Management of Acute Biliopancreatic Disorders Journal of Gastrointestinal Surgery 23(5): 1055-1068.
39. Sandrasegaran K, Patel A, Fogel E.L, Zyromski N.J, and Pitt H.A (2009) Annular pancreas in adults. American Journal of Roentgenology, 193 (2) 455–460.
40. Sato T, Ito K, Tamada T, et al. (2012) Age-related changes in normal adult pancreas: MR imaging evaluation. Eur J Radiology. 81(9):2093–2098
41. Seak Hee Oh, Soo-Hee Chang, Hyun Jin Kim, Jin Min Cho, Ji-Hee Hwang, Jung-Man Namgoong, DaeYeon Kim, Young-Ah Cho, Chong Hyun Yoon, and Kyung Mo Kim (2015) Cholangiographic characteristics of common bile duct dilatation in children. World Journal of Gastroenterology 21(20): 6229-6235.
42. Sharma R, Kandasamy D (2015). Imaging in chronic pancreatitis Pancreapedia: Exocrine Pancreas Knowledge Base. DOI:10.3998/ Pancreas 2015. 26
43. Sheikhi M, Dakhil-Alian M, Bahreinian Z. (2015). Accuracy, and reliability of linear measurements using tangential projection and cone beam computed tomography. Dent Res J (Isfahan),12(3):271–7.
44. Shergill AK, Ben-Menachem T, (2012). Guidelines for endoscopy in pregnant and lactating women. Gastrointestinal Endoscopy,76(1):18–24.
45. Susan Bonner-Weir, C. A.-M. (2016) Dynamic development of the pancreas from birth to adulthoodUpsala Journal of medical sciences, 121(2), 155-158.
46. Suzanne. (2019). Clinical Embryology: An Atlas of Congenital Malformations (1^st ed) Cham, Switzerland: Springer International Publishing AG. Pages 365-371.https// doi .org/10.1007/978-3-319-26158-4.
47. Tadokoro H, Takase M, and Nobukawa B (2008) Unusual fusion between ventral and dorsal primordia causes anomalous pancreaticobiliary junction Pathology International, 58(8) 498–502
48. Tanaka S., Nakaizumi A., Ioka T., Oshikawa O., Uehara H., Nakao M., Yamamoto K., Ishikawa O, Ohigashi H, Kitamra T (2012) Main pancreatic duct dilatation: a sign of high risk for pancreatic cancer. Japan Journal of clinical oncology 32(10):407-11.
49. Russell Taylor , Risto Kojcev , Ashkan Khakzar , Bernhard Fuerst , Oliver Zettinig , Carole Fahkry , Robert DeJong , Jeremy Richmon ,  Edoardo Sinibaldi , Nassir Navab (2017). On the reproducibility of expert-operated and robotic ultrasound acquisitions. International journal of Computer Assisted Radiology and Surgery. 12(6),1003-1011.  DOI: 10.1007/s11548-017-1561-1
50. Taylor AC, Little AF, (2002). Hennessy of Prospective assessment of magnetic resonance cholangiopancreatography for noninvasive imaging of the biliary tree. Gastrointest. Endosc,55 (1): 17-22.
51. Vishy Mahadevan (2019) Anatomy of the pancreas and spleen 37(6):297-301Science Direct
52. Wang Y, Miller FH, Chen ZE et al (2011) Diffusion-weighted MR imaging of solid and cystic lesions of the pancreas. Radiographic 31: E47–E64
53. Wijayapala M H W M N, Ranasinghe D D (2016) Main pancreatic duct (mpd) diameter: contrast enhanced computed tomography (cect) measurement in normal subjects in Sri Lanka. Sri Lanka Journal of Radiology 81: 9.
54. Yu J, Turner MA, Fulcher AS, Halvorsen RA (2006) Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: pancreatic duct and pancreas. American Journal of Roentgenology 187:1544–53.
55. Zehra Hilal Adibelli,Mustafa Adatepe, Cetin Imamoglu, Ozgur Sipahi Esen, Nazif Erkan,and Mehmet Yildirim (2016). Anatomic variations of the pancreatic duct and their relevance with the Cambridge classification system Journal of Radiology and Oncology 50(4): 370-377.