The Pancreatic Sphincter

  • F. B. Keane
  • E. P. DiMagno


The pancreas was one of the last organs to receive the critical attention of early anatomists and physiologists; but since Langerhans described it histologically in 1869, its anatomy and physiology have been the subject of close scrutiny. The pancreatic sphincter mechanism, however, which normally should allow pancreatic secretion to flow into the duodenum and prevent reflux of bile or duodenal contents into the pancreatic ducts, has been difficult to study. Consequently, its physiological functions and the factors that control these functions are largely enigmatic.


Acute Pancreatitis Common Bile Duct Pancreatic Duct Main Pancreatic Duct Pancreatic Secretion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Acosta, J. M. and Ledesma, C. L. (1974). Gallstone migration as a cause of acute pancreatitis. New Engl J. Med., 290, 484–487CrossRefGoogle Scholar
  2. Acosta, J. M. and Nardi, G. L. (1966). Papillitis: inflammatory disease of the ampulla of Vater. Arch. Surg., 92, 354–361CrossRefGoogle Scholar
  3. Adson, M. A. (1979). Surgical treatment of pancreatitis: review of a series. Mayo Clin. Proc., 54, 443–448Google Scholar
  4. Anderson, M. C. and Hagstrom, W. J. Jr. (1962). A comparison of pancreatic and biliary pressures recorded simultaneously in man. Can. J. Surg., 5, 461–470Google Scholar
  5. Arndorfer, R. C., Stef, J. J., Dodds, W. J., Linehan, J. H. and Hogan, W. J. (1977). Improved infusion system for intraluminal esophageal manometry. Gastroenterology, 73, 23–27Google Scholar
  6. Bar-Meir, S., Geenen, J. E., Hogan, W. J., Dodds, W. J., Stewart, E. T. and Arndorfer, R. C. (1979). Biliary and pancreatic duct pressures measured by ERCP manometry in patients with suspected papillary stenosis. Dig. Dis. Sci., 24, 209–213CrossRefGoogle Scholar
  7. Bartlett, M. K. and Nardi, G. L. (1960). Treatment of recurrent pancreatitis by transduodenal sphincterotomy and exploration of the pancreatic duct. New Engl J. Med., 262, 643–648CrossRefGoogle Scholar
  8. Becker, J. M. Ti, T. K., Moody, F. G., Mcgreevy, J. M. and Nelson, J. A. (1979). A model of biliary pancreatic reflux. Surgery, 85, 147–153Google Scholar
  9. Berman, L. G., Prior, J. T., Abramow, S. M. and Ziegler, D. D. (1960). A study of the pancreatic duct system in man by the use of vinyl acetate casts of postmortem preparations. Surg. Gynec. Obstet., 110, 391–403Google Scholar
  10. Bitter, J. M., Telander, R. L. and Hitchcock, C. R. (1965). A comparison of the pancreas of the baboon, dog and man using vinyl resin techniques. In The Baboon in Medical Research, Vol. 1 (ed. H. Vagtborg ), University of Texas Press, AustinGoogle Scholar
  11. Boyden, E. A. (1957a). The anatomy of the choledochoduodenal junction in man. Surg. Gynec. Obstet., 104, 641–652Google Scholar
  12. Boyden, E. A. (1957b). The choledochoduodenal junction in the cat. Surgery, 41, 773–786Google Scholar
  13. Boyden, E. A. (1966). The pancreatic sphincters of the baboon as revealed by serial sections of the choledochoduodenal junction. Surgery, 60, 1187–1194Google Scholar
  14. Byrne, J. J., Reilly, P. S. and Toutounghi, F. M. (1964). Regurgitation in experimental pancreatitis. Ann. Surg., 159, 27–31CrossRefGoogle Scholar
  15. Cotton, P. B. (1977). ERCP: progress report. Gut, 18, 316–341CrossRefGoogle Scholar
  16. Cotton, P. B. (1979). Pancreas divisum: a new cause for pancreatic pain and recurrent pancreatitis [Abstract]. Gastroenterology, 76, 1116Google Scholar
  17. Cubilla, A. L. and Fitzgerald, P. J. (1975). Morphological patterns of primary nonendocrine human pancreas carcinoma. Cancer Res., 35, 2234–2246Google Scholar
  18. DiMagno, E. P., Hendricks, J. C., Go, V. L. W. and Dozois, R. R. (1979). Relationships among canine fasting pancreatic and biliary secretions, pancreatic duct pressure and duodenal type III motor activity—Boldyreff revisited. Dig. Dis. Sci., 24, 684–693CrossRefGoogle Scholar
  19. Dreiling, D. A., Kirschner, P. A. and Nemser, H. (1960). Chronic duodenal obstruction: a mechano-vascular etiology of pancreatitis. I. Report of 6 cases illustrating this clinical variety. Am. J. Dig. Dis., 5, 991–1005CrossRefGoogle Scholar
  20. Drye, J. C. (1948). Intraperitoneal pressure in the human. Surg. Gynec. Obstet., 87, 472–475Google Scholar
  21. Duval, M. K. Jr (1958). The effect of chronic pancreatitis on pressure tolerance in the human pancreatic duct. Surgery, 43, 798–801Google Scholar
  22. Editorial (1977). Surgical treatment of chronic relapsing pancreatitis. Lancet, i, 460–462Google Scholar
  23. Eichhorn, E. P. Jr and Boyden, E. A. (1955). The choledochoduodenal junction in the dog: a restudy of Oddi’s sphincter. Am. J. Anat., 97, 431–459CrossRefGoogle Scholar
  24. Gilsdorf, R. B., Urdaneta, L. F., Delaney, J. P. and Leonard, A. S. (1967). Central nervous system influences on pancreatic secretion, sphincteric mechanisms, and blood flow and their role in the course of pancreatitis. Surgery, 62, 581–588Google Scholar
  25. Go, V. L. W. and DiMagno, E. P. (1977). The pancreas: pancreatic exocrine adenocarcinoma. Br. J. Hosp. Med., 18, 567–576Google Scholar
  26. Greene, E. C. (1935). Anatomy of the rat. Trans. Am. Phil. Soc., 27, 1–370CrossRefGoogle Scholar
  27. Gregg, J. A. (1977). Pancreas divisum: its association with pancreatitis. Am. J. Surg., 134, 539–543CrossRefGoogle Scholar
  28. Gregg, J. A. and Sharma, M. M. (1978). Endoscopic measurement of pancreatic juice secretory flow rates and pancreatic secretory pressures after secretin administration in human controls and in patients with acute relapsing pancreatitis, chronic pancreatitis, and pancreatic cancer. Am. J. Surg., 136, 569–574CrossRefGoogle Scholar
  29. Haff, R. C. and Torma, M. J. (1975). Oddi sphincteroplasty in the management of complicated biliary and pancreatic disease. Am. J. Surg., 129, 509–512CrossRefGoogle Scholar
  30. Hand, B. H. (1963). An anatomical study of the choledochoduodenal area. Br. J. Surg., 50, 486–494CrossRefGoogle Scholar
  31. Hendricks, J. C., DiMagno, E. P.,Go, V. L. W. and Dozois, R. R. (to be published). Reflux of duodenal contents into the pancreatic duct of dogs. Submitted to SurgeryGoogle Scholar
  32. Heuer, G. J. (1906). The pancreatic ducts in the cat. Johns Hopkins Hosp. Bull., 17, 106–111Google Scholar
  33. Howard, J. and Jones, R. (1947). The anatomy of the pancreatic ducts: the etiology of acute pancreatitis. Am. J. Med. Sci., 214, 617–622CrossRefGoogle Scholar
  34. Ivy, A. C. and Gibbs, G. E. (1952). Pancreatitis: a review. Surgery, 31, 614–642Google Scholar
  35. Johnson, R. H. and Doppman, J. (1967). Duodenal reflux and the etiology of pancreatitis. Surgery, 62, 462–467Google Scholar
  36. Jones, S. A., Steedman, R. A., Keller, T. B. and Smith, L. L. (1969). Transduodenal sphincteroplasty (not sphincterotomy) for biliary and pancreatic disease: indications, contraindications, and results. Am. J. Surg., 118, 292–304CrossRefGoogle Scholar
  37. Jordan, G. L. Jr. and Hallenbeck, G. A. (1952). Effect of increased secretory pressure on canine pancreatic secretion. Am. J. Physiol., 170, 211–216Google Scholar
  38. Keane, F. B.,DiMagno, E. P.,Dozois, R. R. and Go, V. L. W. Unpublished dataGoogle Scholar
  39. Keane, F. B., DiMagno, E. P., Dozois, R. R. and Go, V. L. W. (1980). The relationships among canine interdigestive exocrine pancreatic and biliary flow, duodenal motor activity, plasma pancreatic polypeptide, and motilin. Gastoenterology, 78, 310–316Google Scholar
  40. Keane, F. B. V., Fennell, J. S. and Tomkin, G. H. (1978). Acute pancreatitis, acute gastric dilation and duodenal ileus following refeeding in anorexia nervosa. Irish J. Med. Sci., 147, 191–192CrossRefGoogle Scholar
  41. Kyösola, K. and Rechardt, L. (1974). The anatomy and innervation of the sphincter of Oddi in the dog and cat. Am. J. Anat., 140, 497–521CrossRefGoogle Scholar
  42. Kyösola, K. and Rechardt, L. (1975). Electron microscopic observations on the innervation of the sphincter of Oddi in the dog. Cell Tissue Res., 161, 167–176CrossRefGoogle Scholar
  43. Liguory, Cl. and Loriga, P. (1978). Endoscopic sphincteromy: analysis of 155 cases. Am. J. Surg., 136, 609–613CrossRefGoogle Scholar
  44. McCutcheon, A. D. and Race, D. (1962). Experimental pancreatitis: a possible etiology of postoperative pancreatitis. Ann. Surg., 155, 523–531CrossRefGoogle Scholar
  45. Maingot, R. (1974). Abdominal Operations, 6th edn, Appleton-Century-Crofts, New York, p. 768Google Scholar
  46. Mairose, U. B., Wurbs, D. and Classen, M. (1978). Santorini’s duct: an insignificant variant from normal or an important outflow valve. Endoscopy, 10, 24–29CrossRefGoogle Scholar
  47. Menguy, R. B., Hallenbeck, G. A., Bollman, J. L. and Grindlay, J. H. (1958). Intraductal pressures and sphincteric resistance in canine pancreatic and biliary ducts after various stimuli. Surg., Gynec. Obstet., 106, 306–320Google Scholar
  48. Millbourn, E. (1950). On the excretory ducts of the pancreas in man, with special reference to their relationships to each other, the common bile duct and to the duodenum: a radiological and anatomical study. Acta Anat., 9, 1–34CrossRefGoogle Scholar
  49. Miller, M. E. (1964). Anatomy of the Dog, Saunders, PhiladelphiaGoogle Scholar
  50. Ominsky, S. H. (1974). Intravenous cholangiogram contrast medium reflux into pancreatic duct in a patient with acute pancreatitis. Radiology, 111, 97–98CrossRefGoogle Scholar
  51. Opie, E. L. (1901). The etiology of acute haemorrhagic pancreatitis. Johns Hopkins Hosp. Bull., 12, 182–188Google Scholar
  52. Opie, E. L. (1903). Disease of the Pancreas: its Cause and Nature, Lippincott, PhiladelphiaGoogle Scholar
  53. Owyang, C., Dozois, R. R., DiMagno, E. P. and Go, V. L. W. (1977). Relationships between fasting and postprandial pancreaticoduodenal pressures, pancreatic secretion, and duodenal volume flow in the dog. Gastroenterology, 73, 1046–1049Google Scholar
  54. Parry, E. W., Hallenbeck, G. A. and Grindlay, J. H. (1955). Pressures in the pancreatic and common ducts: values during fasting after various meals, and after sphincterotomy; an experimental study. Arch. Surg., 70, 757–765CrossRefGoogle Scholar
  55. Patten, B. M. (1968). Human Embryology, 3rd edn, Blakiston Division, McGraw-Hill, New YorkGoogle Scholar
  56. Perman, E. (1935). Surgical treatment of gastric and duodenal ulcer. Acta Chir. Scand., 77, 142Google Scholar
  57. Persson, C. G. A. (1971). Adrenoreceptor functions in the cat choledochoduodenal junction in vitro. Br. J. Pharmacol., 42, 447–461CrossRefGoogle Scholar
  58. Pour, P., Althoff, J. and Takahashi, M. (1977). Early lesions of pancreatic ductal carcinoma in the hamster model. Am. J. Pathol., 88, 291–308Google Scholar
  59. Pour, P., Kruger, F. W., Chem, D., Althoff, J., Cardesa, A., and Mohr, U. (1974). Cancer of the pancreas induced in the Syrian golden hamster. Am. J. Path., 76, 349–358Google Scholar
  60. Rienhoff, W. F. Jr and Pickrell, K. L. (1945). Pancreatitis: an anatomic study of the pancreatic and extrahepatic biliary systems. Arch. Surg., 51, 205–219CrossRefGoogle Scholar
  61. Rosato, E. F., Oram-Smith, J. C., Reber, H. A., Czernobilsky, B. and Rosato, F. E. (1971). Papillary integrity as a factor in pancreatic reflux. Am. J. Surg., 121, 13–15CrossRefGoogle Scholar
  62. Rösch, W., Koch, H., Schaffner, O. and Demling, L. (1976). The clinical significance of the pancreas divisum. Gastrointest. Endosc., 22, 206–207CrossRefGoogle Scholar
  63. Rosenbaum, H. D., Barker, E. G. Jr, Gibson, D. E. and Griffen, W. O. Jr. (1971). Reflux pancreatography: experimental observations in the cat. Invest. Radiol., 6, 321–325CrossRefGoogle Scholar
  64. Rothwell-Jackson, R. L. (1968). Sphincteroplasty in the treatment of biliary and pancreatic disease. Br. J. Surg., 55, 616–622CrossRefGoogle Scholar
  65. Sankaran, H., Fitzgerald, O. and McGeeney, K. F. (1978). Sphincteric mechanism of the main pancreatic duct in the dog: an experimental model of the isolated sphincteric preparation. Digestion, 72, 221–228CrossRefGoogle Scholar
  66. Schreiber, H. (1944). Der muskelapparat des duodenalen choledochusendes (Papilla Vateri) beim Menschen. Arch. klin. Chir., 206, 211–232Google Scholar
  67. Shingleton, W. W. and Gambourg, D. (1970). Stenosis of the sphincter of Oddi. Am. J. Surg., 119, 35–37CrossRefGoogle Scholar
  68. Simkins, S. (1931). Variations in the pancreatic ducts and the minor duodenal papilla. Am. J. Med. Sci., 182, 629–639CrossRefGoogle Scholar
  69. Singh, M. and Webster. P. D. III (1978). Neurohormonal control of pancreatic secretion: a review. Gastroenterology, 74, 294–309Google Scholar
  70. Tansy, M. F., Salkin, L. M., Innes, D. L., Martin, J. S., Landin, W. E. and Kendall, F. M. (1977). The occlusive competence of the duodenal orifice of the canine pancreatic duct. Surg., Gynec. Obstet., 144, 865–868Google Scholar
  71. Third International Symposium of Digestive Endoscopy, Brussels, February 1977 Google Scholar
  72. Vantrappen, G., Peeters, T. L. and Janssens, J. (1979). The interdigestive complexes of man have both secretory and motor components [Abstract]. Gastroenterology, 76, 1264Google Scholar
  73. Vassilakis, J. S., Manolas, K. and Boundouris, J. (1979). Transduodenal sphincteroplasty. Arch. Surg., 114, 181–184CrossRefGoogle Scholar
  74. Vater, A. (1748). Dissertatio anatomica, qua novum bilis diverticulum circa orificum ductus cholidochi ut et valvulosam colli vesicae felleae constructionem ad disceptandum proponit, atque singularis utriusque structurae eximiam utilitatem in via bilis determinanda exponit. In Albrecht von Haller’s Disputationum Anatomicarum Selectarium, Vol. 3, A. Vandenhoeck, Gottingen, pp. 259–273Google Scholar
  75. White, T. T. (1973). Indications for sphincteroplasty as opposed to choledochoduodenostomy. Am. J. Surg., 126, 165–168CrossRefGoogle Scholar
  76. Wise, R. E. (1962). Intravenous Cholangiography, Thomas, Springfield, Ill., pp. 105–115Google Scholar
  77. Wisniewski, C., Williams, H. T. G. and MacKenzie, W. C. (1963). An experimental study of pancreatitis following Pólya gastrectomy. Can. J. Surg., 6, 210–217Google Scholar
  78. Wynder, E. L. (1975). An epidemiological evaluation of the causes of cancer of the pancreas. Cancer Res., 35, 2228–2232Google Scholar
  79. Yvergneaux, J. P. (1969). Le reflux wirsungien à la lumière du cliché dentaire intra-abdominal, complément de la radiomanométrie. Acta Gastroent. Belg., 32, 225–263Google Scholar

Copyright information

© Paul A. Thomas and Charles V. Mann 1981

Authors and Affiliations

  • F. B. Keane
  • E. P. DiMagno

There are no affiliations available

Personalised recommendations