Abstract
Background
As sphincter action does not functionally affect the union in pancreaticobiliary maljunction (PBM), two-way regurgitation occurs. We investigated the features of acute pancreatitis associated with patients displaying a long common channel.
Methods
We reviewed 3210 endoscopic retrograde cholangiopancreatograms. PBM was diagnosed in 107 patients with a long common channel in which communication between the pancreatic and bile duct was maintained even during sphincter contraction. High confluence of pancreaticobiliary ducts (HCPBD) was diagnosed in 60 patients with a common channel ≧6 mm long in which communication between the two ducts was occluded with sphincter contraction.
Results
Of patients with PBM, four had acute pancreatitis. Etiology of acute pancreatitis in the two patients was suspected to involve impaction in a long common channel. Of patients with HCPBD, 17 displayed acute pancreatitis. Three patients had a history of excessive alcohol intake and 10 patients were associated with choledocholithiasis or cholecystitis. The remaining four patients had no history of them.
Conclusions
Acute pancreatitis occurs in 13% of patients with a long common channel. Obstruction of a long common channel by stones easily induces bile flow into the pancreas. Even if no obstruction is present, biliopancreatic reflux induces acute pancreatitis in some patients.
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References
Sterling JA (1954) The common channel for bile and pancreatic ducts. Surg Gynecol Obstet 98:420–424
Suda K, Miyano T, Konuma I, et al. (1983) An abnormal pancreatico-choledocho-ductal junction in cases of biliary tract carcinoma. Cancer 52:2086–2088
Dowdy GS, Waldron GW, Brown WG (1962) Surgical anatomy of the pancreatobiliary ductal system. Arch Surg 84:229–246
Suda K, Miyano T, Hashimoto K (1980) The choledocho–pancreatico–ductal junction in infantile obstructive jaundice diseases. Acta Pathol Jpn 30:187–194
Kamisawa T, Amemiya K, Tu Y, et al. (2002) Clinical significance of a long common channel. Pancreatology 2:122–128
Kamisawa T, Funata N, Hayashi Y, et al. (2004) Pathologic changes in the non-carcinomatous epithelium of the gallbladder in patients with a relatively long common channel. Gastrointest Endosc 60:56–60
Kimura K, Ohto M, Saisho H, et al. (1985) Association of gallbladder carcinoma and anomalous pancreaticobiliary ductal union. Gastroenterology 89:1258–1265
Sugiyama M, Atomi Y (1998) Anomalous pancreaticobiliary junction without congenital choledochal cyst. Br J Surg 85:911–916
Matsumoto Y, Fujii H, Itakura J, et al. (2002) Recent advances in pancreaticobiliary maljunction. J Hepatobiliary Pancreat Surg 9:45–54
Tashiro S, Imaizumi T, Ohkawa H, et al. (2003) Pancreaticobiliary maljunction: retrospective and nationwide survey in Japan. J Hepatobiliary Pancreat Surg 10:345–351
Swisher SG, Cates JA, Hunt KK, et al. (1994) Pancreatitis associated with adult choledochal cysts. Pancreas 9:633–637
Sugiyama M, Atomi Y, Kuroda A (1999) Pancreatic disorders associated with anomalous pancreaticobiliary junction. Surgery 126:492–497
Kamisawa T, Egawa N, Tsuruta K, et al. (2005) Pancreatitis associated with congenital abnormalities of the pancreaticobiliary system. Hepatogastroenterology 52:223–229
Shimada K, Yanagisawa J, Nakayama F (1991) Increased lysophosphatidylcholine and pancreatic enzyme content in bile of patients with anomalous pancreaticobiliary ductal junction. Hepatology 13:438–444
Nakamura T, Okada A, Higaki J, et al. (1996) Pancreaticobiliary maljunction-associated pancreatitis: an experimental study on the activation of pancreatic phospholipase A2. World J Surg 20:543–550
Okada A, Higaki J, Nakamura T, et al. (1995) Pancreatitis associated with choledochal cyst and other anomalies in childhood. Br J Surg 82:829–832
Stain SC, Guthrie CR, Yellin AE, et al. (1995) Choledochal cyst in the adult. Ann Surg 222:128–133
Lipsett PA, Pitt HA, Colombani PM, et al. (1994) Choledochal cyst disease. A changing pattern of presentation. Ann Surg 220:644–652
Kaneko K, Ando H, Ito T, et al. (1997) Protein plugs cause symptoms in patients with choledochal cysts. Am J Gastroenterol 92:1018–1021
Kamisawa T, Egawa N, Tsuruta K, et al. (2005) Gallbladder carcinoma associated with pancreaticobiliary maljunction presenting as severe acute pancreatitis. J Gastroenterol 40:659–660
Opie EL (1901) The etiology of acute hemorrhagic pancreatitis. Bull Johns Hopkins Hosp 12:182–192
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Kamisawa, T., Tu, Y., Nakajima, H. et al. Acute pancreatitis and a long common channel. Abdom Imaging 32, 365–369 (2007). https://doi.org/10.1007/s00261-006-9057-4
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DOI: https://doi.org/10.1007/s00261-006-9057-4