Symptomatic pancreatic duct stones in the disconnected bile duct: A case series (original) (raw)
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Pancreaticobiliary maljunction and biliary cancer
Journal of Gastroenterology, 2014
Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall. Japanese clinical practice guidelines on how to deal with PBM were made in 2012, representing a world first. According to the 2013 revision to the diagnostic criteria for PBM, in addition to direct cholangiography, diagnosis can be made by magnetic resonance cholangiopancreatography (MRCP), 3-dimensional drip infusion cholangiography computed tomography, endoscopic ultrasonography (US), or multiplanar reconstruction images by multidetector row computed tomography. In PBM, the common channel is so long that sphincter action does not affect the pancreaticobiliary junction, and pancreatic juice frequently refluxes into the biliary tract. Persistence of refluxed pancreatic juice injures epithelium of the biliary tract and promotes cancer development, resulting in higher rates of carcinogenesis in the biliary tract. In a nationwide survey, biliary cancer was detected in 21.6 % of adult patients with congenital biliary dilatation (bile duct cancer, 32.1 % vs. gallbladder cancer, 62.3 %) and in 42.4 % of PBM patients without biliary dilatation (bile duct cancer, 7.3 % vs. gallbladder cancer, 88.1 %). Pathophysiological conditions due to pancreatobiliary reflux occur in patients with high confluence of pancreaticobiliary ducts, a common channel C6 mm long, and occlusion of communication during contraction of the sphincter. Once the diagnosis of PBM is established, immediate prophylactic surgery is recommended. However, the surgical strategy for PBM without biliary dilatation remains controversial. To detect PBM without biliary dilatation early, MRCP is recommended for patients showing gallbladder wall thickening on screening US under suspicion of PBM.
Advances in Medical Sciences, 2008
Purpose: Pancreaticobiliary malunion (PBM) is a distinct disease entity of the pancreatic and biliary ductal system defined as a condition in which the junction of the pancreatic and biliary ducts occurs above the duodenal wall. PBM may be combined with a stenosis of the distal common bile duct and pathological changes in the common bile duct wall (congenital cyst of bile duct), being a potentially malignant condition. Pancreas divisum, resulting from a fusion failure of the ventral and dorsal pancreatic buds, and characterized by a dominant Santorine duct, is considered to be a predisposing factor to recurrent attacks of acute pancreatitis. In incomplete pancreas divisum, the ventral and dorsal pancreas are connected by a segmental branch. Material and Methods: We report a case of a 33-year-old female patient with PBM associated with incomplete pancreas divisum, who had presented episodes of acute cholangitis due to a benign distal common bile duct stricture. Results: Treatment with choledochoduodenostomy and cholecystectomy provided thorough relief and resolution of symptoms. Conclusion: This is the first report of coexistent PBM and incomplete pancreas divisum in a Caucasian patient with unusually late clinical manifestation.
International Journal of Surgery Case Reports, 2018
INTRODUCTION: Multiple and large pancreatic duct stones concomitant with primary choledochal stones is a rare case. Patients usually present with recurrent jaundice and signs of pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the leading method to manage the patients. But ERCP has difficulties when facing the multiple and large stones PRESENTATION OF CASE: Our first case was a 51-years-old man who was admitted to our surgery unit with a diagnosis of chronic pancreatitis. Plain abdominal radiogram, Abdominal MSCT and Magnetic Resonance Cholangiopancreatography (MRCP) showed opacity suspected as stone at the pancreatic duct and distal part of the common bile duct. The second case was a 48-years-old female with the clinical presentation of left upper quadrant pain and history of chronic pancreatitis and intermittent jaundice. Plain abdominal radiogram and MRCP revealed multiple stones in the main pancreatic duct and common bile duct stones. Our third case was female, 60-years-old, who was hospitalized with jaundice and recurrent upper abdominal pain with a history of open cholecystectomy one month previously. Radiologic examination showed multiple stones in the main pancreatic duct and common bile duct. Combined longitudinal pancreatojejunostomy Roux-en-Y and Choledoco-duodenostomy were performed successfully in all cases. Postoperative follow-up showed good recovery of all patients. DISCUSSION: Since ERCP is not proper to be used for multiple and large pancreatic duct stones, we performed a combination of longitudinal pancreatojejunostomy Roux-en-Y and choledoco-duodenostomy to treat the patients and prevent the recurrence. CONCLUSION: The incidence of multiple pancreatic duct stones and large choledochal stones is infrequent. Surgical treatment with combined longitudinal pancreatojejunostomy Roux-en-Y and Choledocoduodenostomy is safe and effective to resolve jaundice and recurrent pain caused by chronic pancreatitis.
Anomaly of The Biliopancreatic Junction with Associated Hepatic Duct Anomaly-A Rare Case Report
International Journal of Cadaveric Studies and Anatomical Variations, 2021
Pancreaticobiliary maljunction (PBM) or anomaly is defined as an anatomical maljunction of the biliary duct and pancreatic duct outside of the duodenal wall beyond the influence of the sphincter of Oddi. Children with this anomaly can present with choledochal cyst with recurrent attacks of acute pancreatitis, and their condition can be worse when not treated appropriately. Pancreaticobiliary maljunction or anomaly is considered to be a major risk factor for biliary tract cancer. In patients with this anomaly, free reflux of pancreatic juice into biliary tract may cause biliary tract damage. This can result in biliary malignancy. Therefore, in this condition, total excision of the extrahepatic bile duct with hepaticojejunostomy is recommended. Early diagnosis of this condition and early surgical treatment is recommended to prevent further complications. Proper follow-up is necessary to detect biliary tract malignancy in the early post-operative period, especially in patients demonstrating post-operative complications. In this article, we presented a case report involving a young male with an abnormal pancreaticobiliary junction (PBM) with choledochal cyst associated with hepatic duct anomaly, biliary stones, and pancreatic stones causing recurrent attacks of acute pancreatitis.
A Case of Gallbladder Cancer Associated with Pancreaticobiliary Maljunction
The Kurume Medical Journal, 2002
We report a case of gallbladder cancer associated with pancreaticobiliary maljunction. The patient was a 60-year-old woman who consulted a local doctor because of discomfort in the right hypochondriac region. Abdominal ultrasonography (US) showed a gallbladder abnormality, and she was referred to Kurume University Hospital, where she was hospitalized for further study and surgery. Abdominal US revealed a sessile tumor with an irregular surface in the fundus of the gallbladder. The internal echo of the tumor was nonhomogeneous, and the structure of the gallbladder wall was partly torn. The common bile duct and the left intrahepatic bile duct were dilated. Abdominal computed tomography (CT) showed an elevated lesion with the same degree of imaging effect as that of the liver on the peritoneal side of the fundus of the gallbladder. The structure of the gallbladder was preserved, and the gallbladder was well demarcated from the surrounding tissue. No hepatic or lymph node metastases were noted. Endoscopic retrograde cholangiopancreatography (ERCP) visualized the pancreaticobiliary maljunction where the pancreatic duct joined the bile duct, entering an approximately 2-cm-long common channel. Dilatation of the common bile duct and intrahepatic bile ducts was observed and diagnosed as the IV-A type according to the Toya classification. Abdominal angiography in the arterial phase showed dilatation of the cystic artery and hyperplasia of vessels but no apparent encasement. In the venous phase, a deep-staining tumor was observed. From the above findings, we made a diagnosis of gallbladder cancer complicating pancreaticobiliary maljunction, and performed an operation. Since intraoperative US showed that the outermost layer of the gallbladder was in part ill-demarcated, we diagnosed the depth of penetration as ss, and performed cholecystectomy and bile duct resection and hepatic resection (S4a and S5), and lymphnode dissection (D2; dissection of groups 1 and 2 lymphnodes). The resected specimen grossly showed a papillomatous lesion with a cauliflower-like surface. The histopathologic diagnosis was papillary adenocarcinoma, depth ss, stage II. Tumor cells proliferated in a papillomatous pattern and were mostly confined to the muscular coat but partly infiltrated into the subserosal coat. In the diagnosis of pancreaticobiliary maljunction, it is crucial to consider complicating gallbladder cancer.
Journal of Ayub Medical College, Abbottabad : JAMC
pancreatitis appears to exist in the presence of such calculi upon radiology. Having said that, pancreatic ductal stone due to biliary causes (origin), in face of acute pancreatitis, is rare. To the best of our knowledge this was the first case of its kind presented to our hospital in recent past. A 25-year-old female presented to the emergency department of our hospital with an acute episode of pancreatitis. Computerized tomography (CT) scan, endoscopic retrograde cholangiopancreatography (ERCP) & magnetic resonance cholangiopancreatography (MRCP) concluded acute pancreatitis (AP) with dilated main pancreatic duct left side branches and intra ductal calculi. The findings were not suggestive of any chronic pancreatitis. Conservative treatment was given for the episodic attack of AP. After the episode resolved, an exploration and extraction of the pancreatic ductal calculus was performed successfully. The pancreatic duct stones were removed by lateral pancreaticojejunostomy (partingt...
Journal of Surgery Research and Practice, 2021
Introduction: Biliary-digestive anastomosis are a fistulization between the bile ducts and the digestive tract that aims at permanent drainage of bile to the digestive tract in case of obstruction at the lower bile duct. The objective of our study was to describe the main techniques and postoperative results of biliary-digestive anastomoses in the treatment of pancreatic head tumors in the visceral surgery department of the Donka national hospital. Material and Methods: This is a descriptive cross-sectional study for 5 years duration from January 01, 2014 to December 31, 2019 which focused on the records of patients who underwent bilio-digestive anastomosis for pancreatic head tumors. Results: The frequency of biliary-digestive anastomosis was 0.38% (N=24). The mean age was 43.75 years with a male predominance of 54.17% (n=13): sex ratio 1.18. The clinical picture was dominated by jaundice, dark urine and stool discoloration in all cases. Abdominal Computed Tomographic (CT) scan and Ultrasound (US) were the reference examinations. The indications were tumors of the head of the pancreas 100% (n=24). The approach was median supra-umbilical in all cases. The types of anastomosis were dominated by choledochodenal anastomosis 54.16% (n=13) followed by cholecysto-jejunal 20.83% (n=5) and choledoco-2
Metachronous cancer of gallbladder and pancreas with pancreatobiliary maljunction
World Journal of Gastrointestinal Surgery, 2010
Pancreaticobiliary maljunction is a congenital anomaly in which the junction between the pancreatic duct and the common bile duct is located outside the sphincter of Oddi. It is well known that pancreaticobiliary maljunction is frequently associated with carcinoma of the biliary tract. We report a case of metachronous cancer of the gallbladder and pancreas associated with pancreaticobiliary maljunction and cystic dilatation of common bile duct in a 68-year-old Tunisian woman who underwent a cholecystectomy for acute cholecystitis. The pancreatic tumor was an adenosquamous carcinoma. Pancreaticobiliary maljunction allows for pancreatobiliary or biliopancreatic reflux which may induce biliary tract carcinoma. Few cases of multifocal cancer associated with this anomaly have been reported. The association with pancreatic carcinoma remains rare. Close attention should be given to both the biliary tract system and pancreas during the long-term follow-up of patients with pancreaticobiliary maljunction, especially after they have undergone a choledochojejunostomy.
Common bile duct stones, an experience in Ondokuz Mayis University
Journal of Experimental and Clinical Medicine, 2013
Common bile duct stones, obstructive jaundice, cholangitis and acute pancreatitis are diseases that can lead to serious complications. In our clinic between May 1993 and October 2011 the results of 101 patients who underwent surgery for common bile duct stone were retrospectively evaluated. Among 101 patients who were included in the study, 45 had symptomatic gallstones accompanied by common bile duct stone, 27 had mechanical icterus, 15 had common bile duct stone and 8 had cholangitis (five patients with suppurative cholangitis), six had acute cholecystitis. Thirthy one patients with common bile duct stones were treated with endoscopic retrograde cholangiopancreatography (ERCP). Surgical procedures were as follows; choledochoduodenostomy in 50 cases, T-tube drainage in 17 patients and transduodenal sphincteroplasty in three patients. Synchronous cholecystectomies were performed in all patients who had not undergone biliary surgery before. Early postoperative mortality was 3.9%. In this study, we detected choledocholithiasis in 11.31% of the all symptomatic cholelithiasis cases. Since our clinic provide tertiary healthcare, this rate becomes 9.85% by excluding those who underwent cholecystectomy for common bile duct stones at other hospitals. Given that the patients who referred to our clinic are in high-risk group, the actual rate of choledocholithiasis in our society is expected to be slightly below that value.