title: Circumportal pancreas: a review of the literature and image findings.
abstract: OBJECTIVE
  Fused pancreatic tissue encasing the portal and/or superior mesenteric vein, circumportal pancreas, is a congenital anomaly that has been associated with operative complications in resections involving the head of the pancreas. We describe this anomaly and highlight its pathophysiology and surgical outcomes through a review of the literature to date, drawings and a computed tomography example.
  
  
  METHODS
  A literature search was undertaken using Pubmed and the search terms "circumportal pancreas," "annular pancreas" and "pancreatic anomaly."
  
  
  RESULTS
  91 cases of circumportal pancreas were identified in the literature. The number of reported cases increased with time. 14 were documented as having undergone surgery (11 carcinoma or suspected carcinoma/3 benign neoplasm). Surgical outcome was reported in 13. Five of 13 (38.5 %) experienced a fistula. Three cases were treated with a drain. One incident of potentially unnecessary surgery due to the misidentification of circumportal pancreas was noted.
  
  
  CONCLUSIONS
  (1) The identification of circumportal pancreas is increasing but is relatively rare. (2) Varying locations of the main pancreatic duct can induce inappropriate construction during pancreaticojejunostomy and can influence the risk of fistula. In the presence of CP, distal pancreatectomy with pancreatic division in front of portal vein creates two sources of pancreatic fistula. (3) The high incidence of associated vascular variants can directly influence pancreatic resection and can affect vascular reconstruction for complete oncologic resection. Therefore, the preoperative location of the main pancreatic duct and presence of any vascular variants in CP must be systematically identified before programed surgery.
authors: Division of Surgery, Mayo General Hospital, Castlebar, Ireland, tarconnelly@rcsi.ie.
authors: Tara M
authors: TM
authors: Connelly
authors: Michelle
authors: M
authors: Sakala
authors: Rafel
authors: R
authors: Tappouni
mesh_terms: D006801:Humans; D010179:Pancreas / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
references: Br J Surg. 1997 Jun;84(6):785
references: 9189086
references: Jpn J Surg. 1987 May;17(3):182-5
references: 3626212
references: Langenbecks Arch Surg. 2007 Jul;392(4):489-91
references: 17221270
references: Case Rep Gastroenterol. 2012 Jan;6(1):131-4
references: 22532811
references: Radiographics. 2006 May-Jun;26(3):715-31
references: 16702450
references: Insights Imaging. 2011 Aug;2(4):409-414
references: 22347962
references: Korean J Gastroenterol. 2012 Jul;60(1):52-5
references: 22832801
references: J Comput Assist Tomogr. 1998 Jan-Feb;22(1):85-6
references: 9448767
references: Transplantation. 2008 Dec 15;86(11):1503-10
references: 19077881
references: J Surg Tech Case Rep. 2012 Jul;4(2):140-1
references: 23741598
references: AJR Am J Roentgenol. 1999 Jul;173(1):193-8
references: 10397125
references: Surgery. 2013 Mar;153(3):434-6
references: 22000830
references: J Laparoendosc Adv Surg Tech A. 2002 Oct;12 (5):333-8
references: 12470407
references: Semin Ultrasound CT MR. 2007 Oct;28(5):395-401
references: 17970555
references: JOP. 2010 Sep 06;11(5):453-5
references: 20818114
references: Surgery. 2009 Jul;146(1):126-7
references: 19541017
references: Radiology. 2005 May;235(2):503-8
references: 15770038
references: Radiology. 1996 Apr;199(1):99-103
references: 8633179
references: Surgery. 2009 Sep;146(3):515-8
references: 19715809
references: J Comput Assist Tomogr. 2008 Jan-Feb;32(1):61-4
references: 18303289
references: Pancreas. 2009 Aug;38(6):713-5
references: 19629006
references: Clin Imaging. 2011 Nov-Dec;35(6):442-6
references: 22040788
references: Surg Today. 2013 Aug;43(8):926-9
references: 22855010