With the development of ultrasound technology, it became possible to visualize the pancreatic duct( or the Virsung duct), as well as the possibility of its measurement.And, often even despite the fact that the duct is not expanded( if the patient does not have a tendency to obesity).
This structure is relatively easy to locate directly in the body of the pancreas, as compared to its tail part or to the head of the organ, since the duct location is more perpendicular to the ultrasound in the body.
This fact contributes to the creation of excellent conditions for conducting pancreas research by acoustic imaging, but in the head of the organ the location of the duct has a certain curvature.Thus, the shadow of the gas, which is in the lumen of the duodenum, can complicate the visualization of the head.
The tail of the organ can hide behind the shadow of the gas gathered in the large intestine or stomach.It is worth noting that the diameter of the pancreatic duct of the pancreatic duct is unchanged if it does not exceed 2 mm when it is visualized.
With regard to the border with the gastric wall, it is identified as a non-echogenic zone.Do not confuse this structure with a perfectly visible pancreatic duct.
Setting a true diagnosis requires a scrupulous study of anatomical features in 2 planes.Visualizing the tubular structure, which can be an enlarged pancreatic duct, one must pay attention to the fact that the spleen vein is next to it.It is necessary to note its curved position, more precisely, its directionality, since its forward bend often points to a visualized space between the pancreas and the stomach.
Pancreas is not identified
Immediately after the laparoscope has been inserted, the pancreas is not visualized.But with a change in the position of the patient's body, it is possible to examine the tail of the organ relatively well through the gastroduodenal ligament.For these purposes, a laparoscope with a 30 ° or 45 ° viewing angle is used, which must be inserted through umbilical access.
For better visualization, the patient should assume a position at which the head end is raised, and a roller is placed under the lumbar region.Mono-or bipolar electrocoagulation is used to separate the gastrointestinal ligament.
In the event that the body is difficult to locate, to improve the visualization conditions, the patient is recommended to drink a little water to create a so-called acoustic window in the stomach.To get an acoustic window and most profitable to visualize the gland, the patient may be asked to sit or turn sideways.
Pancreas is shielded
The intestine and stomach are organs in which active processes of digestion of food pass: the stomach always contains air that dissipates sound waves, and the intestine is usually occupied with digesting food accompanied by gassing.Because the food is able to screen( cover) the pancreas located behind the stomach, it is recommended to perform ultrasound on an empty stomach.
Ultrasound is reflected by gas, and the tissues that are located behind, are shielded due to the acoustic shade from the gas and refraction.Gases in the intestine can screen not only the pancreas, but also the liver, ovaries, uterus, etc.If you can not displace gases in the intestine, then there is a need to produce lateral, oblique or dorsal scans( the patient thus stands or sits).