Clinical Figure and Problems in Cholecystectomy of Septal Structure in the Patients with Low Junction of the Cystic Duct.

Variant anatomy of the biliary system as a cause of pancreatic and peri-ampullary cancers

“…Of note, this figure, 2%, is similar to what has been reported in the literature for general population regarding the incidence of intra-pancreatic union. 21,22 While low union was significantly less common in PDACs of the body/tail compared to PDACs of the head (24% vs 42%, p = 0.002; with the intra-pancreatic insertion occurring in 4% vs 13%, respectively), it was nevertheless still more common than in the non-duct-associated disorders (mucinous cystic neoplasms and intra-hepatic cholangiocarcinomas) (p = 0.04).…”

“…The literature on low union is surprisingly limited. 21,22 It has been implicated in cholelithiasis/choledocholithiasis, 23 -25 pancreatitis 21,26,27 and gallbladder cancer 28 but its potential role in peri-ampullary cancers has not been systematically analyzed. In fact, the data on its frequency is also scarce.…”

“…In fact, the data on its frequency is also scarce. Intra-pancreatic union is reported to occur on average in about 2% 21,22 and lower union (of the distal third of the bile duct between the hepatic hilum and the ampulla of the Vater) in 5.4-15.7% 23,24,27,32 of the population, with an estimated incidence of about 10%. Indeed, in this study, in patients with tumors lacking a connection to the pancreatobiliary ductal system (and thus not subject to milieu changes), namely intra-hepatic cholangiocarcinomas and mucinous cystic neoplasms, the frequency of low insertion was found to be 11%, and more specifically the frequency of the intra-pancreatic form of low union was 2%.…”

“…1) that is seen in 90% of the population. This variation, seen in estimated 10% of the population, has attracted limited attention in the literature, 21,22 with some reports linking it to a higher frequency of cholelithiasis/choledocholithiasis, 23 -25 pancreatitis 21,26,27 and gallbladder cancer. 28 To our knowledge, there is no data analyzing the association of this anatomic variation of the pancreatobiliary tract with any pancreatobiliary disorders or neoplasms.…”