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The body of the pancreas is the longest portion of the gland and runs from the left side of the neck to the tail. It is slightly triangular in cross-section, becoming progressively thinner and less broad towards the tail. The body is described as having three surfaces, anterosuperior, posterior and anteroinferior.

Anterosuperior surface

The anterosuperior surface of the pancreas makes up most of the anterior aspect of the gland close to the neck. Laterally, it narrows and lies slightly more superiorly to share the anterior aspect with the anteroinferior surface. It is covered by peritoneum, which runs anteroinferiorly from the surface of the gland to be continuous with the anterior, ascending layer of the greater omentum (see Fig. 64.4). The superior leaf of the transverse mesocolon is reflected and is continuous with the descending, posterior leaf of the greater omentum just above the anterior border and so forms virtually none of the covering of the anterosuperior surface. It is separated from the stomach by the lesser sac.

Posterior surface

The posterior surface of the pancreas is devoid of peritoneum. It lies anterior to the aorta and the origin of the superior mesenteric artery, the left crus of the diaphragm, left suprarenal gland and the left kidney and renal vessels, particularly the left renal vein (Fig. 70.4). It is closely related to the splenic vein which lies between the posterior surface and the other posterior relations and runs from left to right forming anything from a shallow groove to a near enveloped ‘tunnel’ in the substance of the gland. The left kidney is also separated from the posterior surface by perirenal fascia and fat.

  

Fig. 70.4  A, Posterior relations of the pancreas. Cross sections taken at the mid level of the uncinate process (B), head and neck (C), and tail (D) of the pancreas. See the coronal view for reference of transverse sections.

Anteroinferior surface

The anteroinferior surface of the pancreas begins as a narrow strip just to the left of the neck. As the body runs laterally, it broadens out to form more of the anterior aspect of the body. It is covered by peritoneum which is continuous with that of the posteroinferior layer of the transverse mesocolon. The fourth part of the duodenum, the duodenojejunal flexure and coils of jejunum all lie inferiorly. The lateral end of the inferior border often lies superior and posterior to the splenic flexure. The peritoneum of the anterosuperior layer of the transverse mesocolon is reflected onto the upper part of the anteroinferior surface at the line of the anterior border where it is continuous with the posterior leaf of the greater omentum. The apex of the ligament of Treitz may form an anterior relation of this surface of the body laterally.

Superior border

On the right side, the superior border of the pancreas is initially blunt and somewhat flat, but as the gland is followed to the left, the surface changes to become narrower and sharper. An omental tuberosity usually projects from the right end of the superior border above the level of the lesser curvature of the stomach, in contact with the posterior surface of the lesser omentum. The superior border is related to the coeliac artery. The common hepatic artery runs to the right just above the gland. The splenic artery runs a course that is often highly tortuous to the left along the superior border; it tends to rise above the level of the superior border at several points along its course.

Anterior border

The anterior border of the pancreas separates the anterosuperior from the anteroinferior surfaces. The two layers of the transverse mesocolon diverge along this border. The upper is reflected inferiorly after a very short distance into the descending (posterior) leaf of the greater omentum whilst the other runs downwards and backwards over the anteroinferior surface.

Inferior border

The inferior border of the pancreas separates the posterior from the anteroinferior surfaces. At the medial end of the inferior border, adjacent to the neck of the pancreas, the superior mesenteric vessels emerge from behind the gland. More laterally, the inferior mesenteric vein runs under the border to join the splenic vein on the posterior surface. This is a useful site of identification of the inferior mesenteric vein during left-sided colonic resections and on CT imaging.

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