Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website


Volume 10, Number 5, May 2018, pages 370-375

The Main Anatomical Variations of the Pancreatic Duct System: Review of the Literature and Its Importance in Surgical Practice


Figure 1.
Figure 1. Drawings showing different types of pancreatic duct configuration.
Figure 2.
Figure 2. Summary of the literature research.
Figure 3.
Figure 3. Schematic presentation of the presence of the pancreatic duct types.
Figure 4.
Figure 4. Schematic presentation of the percentages of pancreas divisum types.


Table 1. Classification of the Articles According to the Number and Type of Patients, Type of Investigation, and Type of Study [3-5, 7, 9-14]
AuthorNo. of subjectsType of subjectsType of investigationType of article
*Only some of the patients included in the article were suitable for imaging of the pancreatic duct system. ERCP: endoscopic retrograde cholangiopancreatography; MRCP: magnetic resonance cholangiopancreatography.
Filippo et al [3]350Living patientMRCPProspective study
Adibelli et al [4]1,158Living patientMRCPRetrospective cohort study
Bulow et al [5]927Healthy volunteersStimulating MRCPProspective study
Bang et al [7]582Living patientERCPRetrospective cohort study
Kamisawa et al [9]256/3,210*Living patientERCPRetrospective cohort study
Shahriah et al [10]65CadaverAutopsy of specimensProspective study
Kim HJ et al [11]4,097/10,243*Living patientERCPMulticenter retrospective cohort study
Oracz et al [12]300Living patientMedical records (non specified)Retrospective cohort study
Uomo et al [13]485/650*Living patientERCPRetrospective cohort study
Prasanna et al [14]40CadaverAutopsy of specimensProspective study


Table 2. Classification of the Articles According to the Number of Patients, Normal Pancreatic Duct Anatomy, and Variations [3-5, 7, 9-14]
AuthorNo. of subjects examinedType of subjectsNo. of normalPancreas divisumOther specific types of anomalies
Filippo et al [3]350Living patient3211811
Adibelli et al [4]1,158Living patient1,0915413
Bulow et al [5]927Healthy volunteers83889-
Bang et al [7]582Living patient5311932
Kamisawa et al[9]256/3,210Living patient17581-
Shahriah et al [10]65Cadaver5591
Kim HJ et al [11]4,097/10,243Living patient4,054403
Oracz et al [12]300Living patient2523315
Uomo et al [13]485/650Living patient4372622
Prasanna et al [14]40Cadaver382-
Total8,2608 living patients7,792 (94.3%)371 (4.5%)97 (1.2%)
1 healthy volunteers
2 cadavers


Table 3. Classification of Patients According to the Type of the Pancreatic Duct Course and Configuration [3-5, 7, 9-14]
AuthorNo. of subjects examinedType 1Type 2Type 3Type 4Type 5Other specific types of anomalies
*Patients with type 1, type2 and type 3 were not discriminated due to the different type of classification. +Patients that could not be classified in one of the described types according to the classification that was used in this article. Patients with APBU were not discriminated from the types 1 to 5 but they were reported separately.
Adibelli et al [4]1,158521 (45%)42 (3.6%)528 (45.6%)54 (4.6%)13 (1.2%)No annular pancreas, agenesis, hypoplasia, dorsal pancreas, accessory lobe, 2APBU (0.17%)
Bulow et al [5]927209 (22.5%)45 (4.8%)+584 (63%)89 (9.6%)--
Shahriah et al [10]655 (7.69%)3 (4.6%)47 (72.3%)9 (13.8%)-1 duct in 3d papilla
Bang et al [7]582531 (91,2%)* non corresponding types19 (3.3%)-32 (5.5%) duplication anomalies (5 number - 27 form variants)
Filippo et al [3]350321 (91.8%) non specified type18 (5.2%)-11 ABPU (3%) no annular
Prasanna et al [14]4038 (95%)Excluded from study2 (5%)--
Kamisawa et al [9]256/3,210175 (68.3%) non specified type81 (31.6%)-74 ABPU (28.9%)
Uomo et al [13]485/650437 (90,1%) non specified type26 (5.3%)-22 Duplications (13 bifid MPD, 4 loop, 2 N-shaped, 3 ring shaped )
Kim HJ et al [11]4,097/10,2431,216 (37.7%) non specified type but with APD2,838 (69.3%)40 (0.49%)-2 annular (0.05%), 1 santorinocele, 30 APBU (4.1%)
Oracz et al [12]300252 (84%) non specified type33 (11%)8 (2.7%)4 ABPU, 3 rare (1%) anomalies
Total8,2607,792 (94.3%)371 (4.5%)21 (0.25%)76 (0.92%)


Table 4. Evaluation of Pancreas Divisum and Its Types
Pancreas divisumType 1Type 2Type 3
Adibelli et al [4]242010
Bang et al [7]12-7
Bulow et al [5]67-89
Kamisawa et al [9]161015
Total119 (44%)30 (11.11%)121 (44.8%)