A CLINICAL STUDY ON DIFFERENTIAL DIAGNOSIS OF PANCREATIC DUCT ANOMALY

Abstract

Pancreatic duct anomalies such as congenital aplasia of the pancreatic body and tail, and pancreas divisum are the relatively rare conditions found on endoscopic retrograde cholangiopancreatography (ERCP) . It has been thought that the diagnosis of these anomalies should be made by surgical intervention. Because of the lack of therapeutic indication of laparotomy for such cases, it is necessary to establish nonoperative diagnostic criteria for cases with pancreatic duct anomaly. Differences in endoscopic cholangiopancreatograms between pancreatic duct anomaly and pancreatic cancer with a short main pancreatic duct were investigated. Four cases of pancreatic duct anomaly (I cases of congenital aplasia of the pancreatic body and tail, and 3 cases of pancreas divisum) showed neither disruption of the main pancreatic duct nor irregularity of the branch. On the contrary, all of 12 cases with pancreatic carcinoma revealed an obstruction of the main pancreatic duct and irregularity of the branch. No abnormal changes of the common bile duct were observed in cases of pancreatic duct anomaly. Obstruction or narrowing of the choledochus was observed in 11 of 12 cases of pancreatic cancer. Santorini's duct were opacified by cannulating the major duodenal papilla in case of aplasia of the pancreatic body and tail, and 7 of 12 patients with pancreatic carcinoma. Successful opacification of a dorsal pancreatic duct was obtained by cannulating the minor duodenal papilla in all of 3 cases of pancreas divisum. Abdominal angiography and computed tomography demonstrated abscence of the pancreatic body and tail clearly and contributed to the diagnosis in case of congenital aplasia of the pancreatic body and tail. In conclusion, the diagnosis of pancreatic duct anomaly is possible by means of carefull interpretation of ERCP, abdomdnal angiography and computed tomography without surgical intervention.