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.
A case of duplication of the bile duct was reported. A 39-year-old-female, with epigastralgia, was admitted to the Showa University Hospital. The ERCP and endoscopic examination revealed duplicated hepatic duct; the accessory left hepatic duct was opened into the lesser curvature of the stomach, while the bile stream was mainly drained through the common bile duct into the Papilla Vater. Partial gastrectomy with extirpation of the accessory left hepatic duct and incidental cholecystectomy were carried out.To our knowlege, 24 cases of duplication of the bile duct have been reported in Japan. According to the classification described by Saito and Others, there were 15 cases of type IIIb, 4 of type II and each one of type I and IV. Abnormal opening portion of the duplicated bile duct included the lesser curvature of the stomach in 12 cases, the duodenum in 10, and the pancreatic duct in one. In the remaining case, the duplication of the common bile duct was observed. Cholelithiasis was associated with in 8 cases, gastric carcinoma in 4, cholecystitis in 2 pancreatic carcinoma in one, and liver and splenic absess in one. Surgery was performed in at least 16 cases, in 14 of which surgery was performed for the associated diseases, while only in 2 for duplication of the bile duct. Seven cases were treated non-surgically and unknown in one.Surgical intervention should be performed in type IIIb duplication of the bile duct, because of the following reasons; 1) biliary infection may produce cholelithiasis and/or cholecystitis; and 2) chronic stimulation of the bile juice to the gastric mucosa may result in an increase of risk of gastric carcinoma.
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