Abstract
The pancreas is a centrally located extraperitoneal organ within the anterior pararenal space. It is extensively connected to the extraperitoneal spaces by location and a network of mesenteries and ligaments. This provides interconnected avenues for vessels, lymphatics, and nerves to course through-as well as avenues for the spread of disease. The head of the pancreas results from the fusion of its ventral analog (anterior head) with its dorsal analog (posterior head). This differentiation provides two distinct pathways of spread of disease from the head of the pancreas. This communication will discuss the embryology, anatomy, and pathways of disease spread from the anterior and posterior pancreatic head. While any disease process can use these pathways, proven cases of adenocarcinoma of the pancreas are used for illustrations.