Pancreas mobile

Abstract

Background and Aim: Up to now, little is known about the mobility of the pancreas due to changes in posture. The present study was conducted to assess the position of the pancreas in the left recumbent posture (endoscopy posture), the pancreatic mobility during changes of the posture from supine to endoscopy posture and also evaluates the possible factors associated with pancreatic mobility.

Methods: 199 patients with (68) or without chronic pancreatitis were examined using conventional gray-scale transabdominal ultrasound to image the position and mobility of the pancreatic head with reference to the vertebral spine and aorta in the supine and left recumbent position. In a subgroup of 75 consecutive healthy subjects regarding the pancreas, the exact moving distance of the central line of the pancreatic head from the supine to left recumbent position was obtained regarding the central line of the spine as the reference. Besides the 199 patients, 50 patients without pancreatic pathology were evaluated by endoscopic ultrasound with radial transducers.

Results: On conventional ultrasound in supine (left lateral) position the percentage of patients with right-aortal, pre-aortal, left-aortal pancreatic head were 91.0 % (49 %), 8.0 % (31 %) and 1.0 % (20 %), respectively. Significant movement of the pancreatic head in relation to the aorta was observed in 48 % of patients. The moving distance was correlated to the age, sex and the presence of chronic pancreatitis. Pancreas mobility was more pronounced in young healthy females. No association was found between the moving distance and the body mass index (BMI) and splenic size. On endoscopic ultrasound, the orientation of the pancreas with a view of more (or equal) than 180^o was observed in 48 % and less than 180^o in 52 % of patients.

Conclusion: Pancreas mobile is a common phenomenon (about 50 %) which has not often been recognized in daily routine. This phenomenon is more likely in healthy young females. This knowledge might be of importance for improved interpretation of endoscopic ultrasound imaging examinations in patients with and without peripancreatic infiltration.

Zusammenfassung

Hintergrund und Studienziel: Das Pancreas mobile ist ein bisher in der Literatur wenig beachtetes Phänomen. Veränderungen der Lagevariabilität könnten eine Bedeutung für die Diagnostik entzündlicher und neoplastischer Pankreaserkrankungen haben. Die postulierte Lageänderung in strenger Linksseitenlage wäre insbesondere bei der endoskopischen Ultraschalluntersuchung (EUS) von Bedeutung.

Methode: 199 Patienten mit (68) oder ohne Zeichen der chronischen Pankreatitis wurden in die Studie eingeschlossen. Mittels konventioneller B-Bild-Sonographie wurde die Lage des Pankreaskopfs in Relation zur Aorta und Wirbelsäule in Rückenlage und in strenger Linksseitenlage („endoskopische Position“) des Patienten untersucht. Des Weiteren wurde die Form des Pankreas bei 50 Patienten mit endoskopischem Ultraschall untersucht. Kriterium war das Ausmaß der Pankreasdarstellung in einem Bildausschnitt (> oder ≤ 180^o).

Ergebnisse: Der Pankreaskopf befand sich in Rückenlage (Linksseitenlage) bei 91 % (49 %) der Patienten rechts vertebral, bei 8 % (31 %) antevertebral (mittig) und bei 1 % (20 %) links der Wirbelsäule. Die Beweglichkeit des Pankreas korrelierte negativ zum Alter des Patienten und zum Vorliegen einer chronischen Pankreatitis. Das Pancreas mobile fand sich gehäuft bei gesunden jungen weiblichen Patienten. Es fand sich keine Assoziation zum Body-Mass-Index (BMI) und zur Milzgröße. Mittels EUS fand sich das Pancreas mobile bei 48 % > 180^o und bei 52 % ≤ 180^o.

Schlussfolgerung: Das Pancreas mobile ist häufiger als bisher vermutet insbesondere bei jungen Frauen. Die Mobilität des Pankreas ist für die Endosonografie von Bedeutung, da sich das longitudinal ausgerichtete Organ U-förmig verändern kann. Eine eingeschränkte Beweglichkeit findet sich insbesondere bei entzündlichen und neoplastischen Erkrankungen mit Infiltration der Umgebung.

Schlüsselwörter

Endosonographie - Pankreatitis - Pankreaskarzinom - Lagevariabilität

Key words

endoscopic sonography - pancreatitis - pancreatic cancer - positional variability

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