0:01

So before we start dealing with the

0:02

congenital anomalies, we need to

0:03

know embryology of the pancreas.

0:05

Uh, during the embryological age, pancreatic

0:09

buds are developed as ventral and dorsal

0:11

buds along with the primitive duodenum.

0:13

And the ventral bud also gives rise to the CBD.

0:16

And what happens afterwards, the ventral

0:18

bud rotates all the way backwards,

0:20

ventrally, to fuse with the dorsal duct.

0:22

And both of these separate ducts

0:24

are present for each of the bud.

0:26

The duct for the dorsal duct is called

0:27

as duct of Santorini, and for the ventral

0:30

duct, it is called as duct of Wirsung.

0:32

And eventually what happens, these, both of the

0:34

ducts fuse together to form the main pancreatic

0:37

duct, which opens into the major papilla here.

0:40

And the dorsal duct, or duct of Santorini

0:42

here, continues with the minor papilla.

0:45

So it can happen that fusion can occur in such

0:47

a way that you have persistent duct of Santorini,

0:50

and this duct never fuses, or never develops.

0:53

So those can give rise to different

0:54

kinds of anomalies, and we are

0:56

going to deal with them one by one.

0:59

The most common anomalies which we

1:00

deal with in the real practice is divisum.

1:02

We see a lot.

1:04

It is usually asymptomatic.

1:07

If it is symptomatic, that will lead to,

1:09

most likely, pancreatitis, because what is happening

1:11

here, we are draining all the pancreatic

1:13

enzymes through the minor papilla, and that

1:16

will lead to pain abdomen or pancreatitis.

1:18

And good thing to know that if you see an

1:20

outpouching, a small outpouching at the end

1:23

of the minor papilla, arising from the duct of

1:26

Santorini, in a case of divisum, that is a

1:28

suggestion that possibly that is causing

1:30

the patient suffering from the pancreatitis.

1:33

So, this is the pancreas here.

1:35

And we have duct of centurine or dorsal

1:37

duct draining to the main parenchyma.

1:40

And in divisum what can happen is that

1:42

there is no ventral duct at all.

1:44

Like in, here I am showing you.

1:46

And there is no communication, there is no duct.

1:48

But sometimes you can have the ventral duct

1:51

which is present, which is diminutive.

1:53

And it doesn't fuse with the main duct.

1:55

And the third type, we can have the communication

1:58

between the ventral duct and the dorsal duct.

2:00

But this communication is

2:02

kind of very, very small.

2:03

Very Dimi, and that doesn't function at all.

2:06

So practically it is not functioning.

2:08

And all of the secretions are coming from the

2:10

main duct to drain into the minor papilla here.

2:13

So these are the three different

2:14

types of divisum, and this is the way

2:17

we can pick up divisum on MRCP images.

2:20

We can see the main pancreatic duct and

2:21

that drains to the, the minor papilla and

2:24

the CBD drains to the major papilla, and

2:26

we cannot even see the vent duct here.

2:29

And this crisscross pattern is very, very

2:30

diagnostic, very specific for, for divisum.

2:34

And here we can see on the axial images,

2:35

on T2 weighted images, we can see the main

2:38

pancreatic duct is draining towards the minor

2:39

papilla and the CBD is posterior to that.

2:41

Usually, the ventral duct should come here and

2:44

join together to open with the major papilla here.

2:48

And this is how we can differentiate between the

2:50

divisum and persistent duct of centurine here.

2:53

If we have dominant ventral duct,

2:55

which joins with the main duct here, that will

2:56

be called as persistent duct of centurine.

2:59

And this may or may not be symptomatic

3:00

at all, because we have still the

3:03

main channel which is functioning.

3:04

And everything is draining

3:05

towards the major papilla.

3:07

So, be sure that you understand the

3:08

difference between the persistent

3:10

duct of centurine and divisum.

3:12

And they are different, but they are very close.

3:15

And this is the case I am going to

3:16

show you on this Cine loop, how we

3:20

can see the crisscross pattern here.

3:21

This is the duct draining to the minor

3:23

papilla and then we are seeing the major

3:25

duct coming downwards with the CBD here.