Anatomy of the pancreas and spleen

The pancreas is a large, retroperitoneal organ situated immediately behind the posterior wall of the lesser sac, in the floor of the supracolic compartment of the abdominal cavity. Although principally an exocrine gland, the pancreas also performs crucially important endocrine functions. The exocrine pancreas secretes digestive enzymes. These are produced by the pancreatic acini and released into an elaborate ductal system which eventually opens into the second part of the duodenum. The endocrine component of the pancreas is represented by the islets of Langerhans that are present diffusely in the pancreatic substance. The islets are microscopic collections of cells whose secretions include pro-insulin and glucagon; hormones of vital importance in carbohydrate metabolism. Its deep location and its close topographical relationship to several vital structures make pancreatic surgery both challenging and hazardous. A sound appreciation of the topographical, vascular and ductal anatomy of the pancreas is fundamental to the successful surgical management of pancreatic cancers, congenital malformations of the pancreas and various surgical complications of acute pancreatitis.The spleen is the largest lymphoid organ in the body. It is situated deep in the left hypochondrium, wedged between the gastric fundus, left hemidiaphragm and left kidney. Trauma, lymphoid neoplasia, gastric cancers, portal hypertension and idiopathic thrombocytopenia may necessitate splenectomy. A sound knowledge of the surgical and functional anatomy of the spleen is essential if splenectomy is to be performed safely and effectively.