27 Pancreaticoduodenal vessels

It is difficult to separate the duodenum from the pancreas because their arterial systems are intertwined. In our opinion, the duodenum merits more medical attention than it receives because, embryologically, it is the origin of the liver and the pancreas. In medicine the duodenum is rarely cited, as it is obscured by ‘gastric’ pains.

27.1 Anatomy

We will see that the arteries common to the duodenum and pancreas arise from the gastroduodenal artery (Fig. 27.1).

Fig. 27.1 Duodenum and pancreas.

27.1.1 Pancreaticoduodenal arteries

The common hepatic artery gives origin to the gastroduodenal artery from which arise the:

• anterior superior pancreaticoduodenal artery

• posterior superior pancreaticoduodenal artery

• inferior pancreaticoduodenal artery. This is a branch of the superior mesenteric artery, which ascends to anastomose with the superior pancreaticoduodenal artery.

27.1.2 Remarks on the duodenum

The arterial irrigation of the duodenum is the same as that of the head of the pancreas. Its cephalad part (first part of the duodenum) is intraperitoneal and very dependent on the mobility of the liver.

The second part of the duodenum is retroperitoneal and is almost always implicated in any right renal fixations. One could almost speak of a duodenorenal ‘flirtation.’ It is at the duodenojejunal flexure that the small intestine becomes intraperitoneal.

27.1.3 Remarks on the pancreas

It is sometimes difficult to imagine that this gland, 15 cm long and weighing a few hundred grams, is able to produce 2 L of secretions daily.

In our courses, we usually describe the pancreas in three parts: the head, the body, and the tail. Even if this division is contestable, physiologically the head relates mainly to exocrine function, whereas the body and the tail correspond to endocrine function. This classification emerged from our clinical experience, Listening Techniques and Manual Thermal Evaluation. The more serious the pancreatic problem, the more the hand is attracted towards the tail in Listening.

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