Fusion variations of the pancreatic ducts were studied to elucidate the significance of such variations. We classified structural fusion anomalies of the main and accessory pancreatic ducts on endoscopic retrograde cholangio-pancreatography (ERCP) in 37 patients with anomalous arrangement of the pancreaticobiliary ductal system (AAPB). The fusion variations of the pancreatic ducts were classified into five types: common, ansa pancreatica, branch fusion, looped, and separated. These fusion variations, except for common type, were found in 68% of the 37 patients with AAPB on ERCP. Fusion variations of the pancreatic ducts were very frequent (93%) in the 30 patients with congenital cystic dilatation of the common bile duct (CCD). The branch confluence fashion, in which the terminal bile duct communicated with a pancreatic duct branch, was found only in patients with cystic dilatation cyst of the CCD, and it appeared that cystic dilatation cyst of CCD might differ from spindle or cylindrical cyst originating from embryonic formation of an anomalous confluence. It was also suggested that in patients with fusion variations of the pancreatic ducts, the flow of pancreatic juice might be disordered, leading to the development of acute pancreatitis or pancreatic dysfunction. Consequently, it appears to be necessary to carefully examine patients with AAPB for the presence or absence of any fusion variations of the pancreatic ducts and to observe such patients with long-term monitoring by ERCP, and computed temography, and with pancreatic function tests.
: Herein we report on an extremely rare case of ulcerative colitis UC with onset after chemotherapy and colorectal resection, and discuss three previously reported cases. A 61-year-old man presented with fecal occult blood and no subjective symptoms. The diagnosis was rectal cancer with multiple liver metastases. Following chemotherapy, the patient underwent laparoscopy-assisted super-low anterior resection, liver resection. On Day 35 following closure of the ileostomy, the patient was referred to Totsuka Kyoritsu Dai-1 Hospital because of diarrhea, bloody stools. Colonoscopy and pathological examination revealed UC. To the best of our knowledge, only three cases of UC following colorectal cancer resection have been described previously. In conclusion, when encountering intractable diarrhea after chemotherapy or surgery, UC should be one of the bowel diseases considered, with prompt systemic examination recommended.
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