The Pancreas

The casual observer might be forgiven for assuming that the pancreas plays an insignificant role given its size, morphology, and location. Indeed, Galen and anatomists for a millennium considered the pancreas a fatty cushion on which the stomach rested. In truth, this largest digestive gland, situated in the center of the body, on either side of the transpyloric (L1) plane, is notable for its complex anatomy and the colocation of exocrine and endocrine organs. The pancreas is an organ of endless fascination, with congenital anomalies giving rise to a range of anatomic variations, anatomic relations challenging the most meticulous surgeons, and wide-ranging pathology of clinical significance. Surgical management of pancreatic disease requires a detailed understanding of the anatomy of the pancreas and its relation to adjacent vital structures, and the management of patients with diseases related to the pancreas requires a detailed understanding of the physiology of both the exocrine and the endocrine pancreas. The functional reserve of the gland is such that over 50% of its acinar tissue must be destroyed before there is marked evidence of an effect on digestion, and more than 70% o