STEP 4Locating the main pancreatic duct A1A2

To find the pancreatic duct, the main duct in the body of pancreas is usually located eccentrically, closer to the superior border and deeper toward the posterior surface of the gland.

If large, the duct may bulge from the anterior aspect of the gland or, if smaller, palpated or balloted as a "groove" along the long axis of the gland.

To identify a small duct, we connect a 10-ml syringe to a 23-gauge butterfly needle aiming obliquely and posteriorly in the suspected direction of the duct; avoid the neck of the pancreas when searching/aspirating to minimize injury to the underlying SMV; aspiration of clear fluid is an indication the duct has been located.

Measure duct pressure by connecting the needle to the manometer; in our experience, average pancreatic ductal pressure in chronic pancreatitis patients is 33 cmH2O (range: 20-47cmH2O), in contrast to a normal ductal pressure of ~10cmH2O.

Leave the needle in the duct.

The duct of Wirsung in the neck of the pancreas is usually eccentric and slightly superior and posterior (closer to the SMV/portal vein).

anterior anterior

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