Surgical Anatomy, Anomalies, and Normal Variants of the Pancreas

The pancreas is a digestive organ with both exocrine and endocrine functions that sits in the retroperitoneum at the level of the second lumbar vertebra. It has an extremely close spatial relationship with multiple organs (i.e., the duodenum, stomach, transverse colon, and bile duct) and multiple major blood vessels, including the celiac axis, superior mesenteric artery and vein, portal vein, and vena cava. Acknowledgment and understanding of these close proximities is vital when performing surgical procedures involving the pancreas. Knowledge of pancreatic embryology is also key for the identification of congenital anomalies and their relevance for patients. An in-depth understanding of overall pancreatic anatomy and normal variants is also critical for the proper diagnosis and treatment of any potential resulting pancreatic pathology. Anatomic anomalies and variations of the pancreas include pancreas divisum, annular pancreas, ectopic pancreas, pancreatic agenesis and hypoplasia, pancreatic cysts, and variations of the course and configuration of the duct.