Clinical Analysis of Anomalous Pancreaticobiliary Ductal Union.
- Author:
Ki Hun KIM
1
;
Sung Gyu LEE
;
Young Joo LEE
;
Kwang Min PARK
;
Shin HWANG
;
Dong Lak CHOI
;
Chung Hyun NAM
;
Pyung Chul MIN
;
Sung Koo LEE
Author Information
1. Department of Surgery, College of Medicine, University of Ulsan and Asan Medical Center, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Anomalous union of the pancreaticobiliary duct
- MeSH:
Abdominal Pain;
Adult;
Bile;
Bile Ducts;
Biliary Tract;
Cholangiopancreatography, Endoscopic Retrograde;
Cholecystectomy;
Chungcheongnam-do;
Classification;
Dyspepsia;
Female;
Fever;
Humans;
Jaundice;
Pancreatic Diseases;
Pancreatic Juice;
Pancreatitis;
Recurrence
- From:Journal of the Korean Surgical Society
1999;57(3):428-435
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: With improvements in the performance of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing hepatobiliary and pancreatic diseases, anomalous unions of the pancreaticobiliary duct (AUPBD) have come to our attention in recent years. Such unions are thought to be a factor in the development of carcinomas of the pancreaticobiliary system. The purpose of the present study was to evaluate the clinical analysis of AUPBD for proper treatment. METHODS: During the past 4 years from January 1, 1993, to December 31, 1997, 28 adult patients with AUPBD, in whom the pancreaticobiliary ductal union and terminal biliary tract were opacified by ERCP, were seen at Asan Medical Center. We divided the types of AUPBD according to Kimura's classification. RESULTS: The ages of the patients (20 women and 8 men) with this anomaly ranged from 16 to 68 years. The patients' main complaints were abdominal pain (16 cases), indigestion (10 cases), jaundice (4 cases), and fever (2 cases). The common channel measured on direct cholangiograms was 15 mm to 42 mm long. All of the patients whose anomalies were confirmed by ERCP had combined diseases (benign diseases 20 cases, malignant diseases 8 cases). Of the 20 patients with benign diseases, the 15 patients who underwent operative treatments had no recurrent findings or symptoms, but all of the 5 patients who underwent conservative treatments had recurrent pancreatitis or indigestion. These 5 patients will still need to be followed up. For the 8 patients with malignant diseases, the 3 who did not undergo operations died of far-advanced cancer. Among the remaining 5 patients who underwent operative treatments, 1 patient died of cancer recurrence, but 4 patients have been alive since their operations. CONCLUSIONS: We think that all ERCP examinations have to be carried out with AUPBD in mind. It is important to remove the place that causes bile stasis and to stop backflow of pancreatic juice intothe bile duct in managing patients with this anomaly. Therefore, a prophylactic cholecystectomy and reconstruction of the biliary tract are both necessary in treating AUPBD.
