Risk Factors for Pancreatitis in Anomalous Union of Pancreatobiliary Duct with Choledochal Cyst

Jeong, Ji Bong; Kim, Yong Tae; Yoon, Yong Bum; Hwang, Jin Hyeok; Kim, Chung Yong

Abstract

BACKGROUND/AIMS: The clinical features of pancreatitis in patients with anomalous union of pancreatobiliary duct (AUPBD) are not known well. We analyzed the pathogenic mechanisms, risk factors, and clinical courses after treatment in patients with AUPBD. METHODS: We retrospectively reviewed the medical records and cholangiopancreatograms of 58 patients with AUPBD and choledochal cyst diagnosed in Seoul National University Hospital between 1982 and 2001. RESULTS: The incidence of pancreatitis was significantly higher in patients with a long common channel length (>21 mm), wide common channel diameter (>5 mm), wide diameter of proximal pancreatic duct (>2.5 mm), filling defect in the common channel, and pancretic duct anomaly. However, age, sex, type of choledochal cyst, type of AUPBD, diameter of the bile duct, angle between the pancreatic duct and bile duct, biliary stone, and pancreticobiliary malignancy were not associated with the risk of pancreatitis. Patients underwent cyst excision (n=9), choledochocystojejunostomy (n=1), pancreas head resection (n=3), or conservative management only (n=3). Pancreatitis recurred in 3 of the 16 patients treated during a mean follow-up of 37.5 months. Bile reflux to the pancreatitc duct seems to be the main mechanism of pancreatitis in AUPBD, considering the fact that choledochal cyst excision prevented pancreatitis recurrence. CONCLUSIONS: Morphological characteristics of the common channel and pancreatic duct contribute to the development pancreatitis in patients with AUPBD and choledochal cyst probably due to the bile reflux into the pancreatic duct.