Pancreaticobiliary maljunction: Etiologic concepts based on radiologic aspects

Pancreaticobiliary maljunction: pathophysiological and clinical aspects and the impact on biliary carcinogenesis

“…Consequently the hypothesis shown in Fig. 5 is that PBM arises due to a misarrangement in which the terminal bile duct is joined with one of the ducts of the ventral pancreas, including the main pancreatic duct [5]. However, we have encountered no PBM case in which the bile duct joins the dorsal pancreatic duct system.…”

“…However, the sphincteric action affects the junction in PBM patients with a short common duct as shown in Fig. 10 but not in PBM patients with a long common duct [5] (Fig. 6).…”

“…Recently we proposed the hypothesis based on the radiological and anatomical analyses of patients with PBM that the long common channel actually represents Wirsung's duct system [5], and Fig. 2 shows the long common channel and small radicles arising from the main pancreatic duct.…”

“…It is now thought that there is no relationship between the embryonic cause of PBM and that of CCBD. However, as these anomalies are both thought to occur during the early period of gestation [5], PBM at the end of the third or the beginning of the fourth week, and CCBD from the sixth to tenth week, the preexistence of PBM may disturb the recanalization of the primitive bile duct [9].…”

“…Yotuyanagi and Babbitt suspected that the narrow duct system was a predisposing factor in the occurrence of CCBD, and subsequently this hypothesis became well known throughout the world. However, many PBM cases without CCBD have been reported in Japan since Babbitt's report, and PBM is now thought to be a different anomaly from CCBD in embryology [5]. Therefore the characteristic clinical aspects of PBM cases should be clarified.…”