Superior pancreaticoduodenal nodes

At a glance

English

Superior pancreaticoduodenal nodes

Latin (TA2)

Nodi pancreaticoduodenales superiores

System

Lymphatic

Region

Trunk

Side

Single, on the midline

About the superior pancreaticoduodenal nodes

The pancreaticoduodenal nodes lie in the curve of the duodenum, where the head of the pancreas nestles inside the C-shaped loop. They follow the arterial arcades that run in front of and behind the pancreatic head. The superior set belongs to the upper part of that ring, along the anterior and posterior superior pancreaticoduodenal arteries, which arise from the gastroduodenal artery. An inferior set follows the inferior pancreaticoduodenal vessels from the superior mesenteric artery below.

This split reflects the double blood supply of the region. The pancreatic head and duodenum sit on the border between the territory of the coeliac trunk and that of the superior mesenteric artery, and their lymph divides along the same line.

Lymph reaches the superior set from the upper part of the pancreatic head, from the first and second parts of the duodenum, and from the lower end of the common bile duct as it passes behind and through the pancreatic head. Their efferent vessels empty into the hepatic nodes along the common hepatic artery, and these in turn drain to the coeliac nodes and the cisterna chyli.

These nodes are among the first reached by cancer of the pancreatic head, of the lower bile duct, of the ampulla and of the duodenum. For that reason they are removed with the specimen in a pancreaticoduodenectomy, the Whipple operation, and examining them is central to staging. They may also enlarge in duodenal ulcer disease and in pancreatitis, and can press on the bile duct to cause jaundice when greatly swollen.

Course and drainage

Begins at

Afferent vessels from the upper part of the head of the pancreas, the first and second parts of the duodenum and the lower common bile duct.

Drains into

Efferent vessels empty into the hepatic nodes along the common hepatic artery, then to the coeliac nodes.

Drains

Filters lymph from the pancreatic head, upper duodenum and lower bile duct. An early site of spread for pancreatic head, ampullary and bile duct cancer, removed in a Whipple operation.