CLINICAL STUDY ON PANCREATITIS ASSOCIATED WITH ANOMALOUS ARRANGEMENT OF PANCREATICO-BILIARY DUCT

Abstract

Out of 23 cases of an anomalous arrangement of pancreatico-biliary duct encountered in our department and the affiliated institutions during the last 8 years, 2 cases (9%) were complicated with acute pancreatitis and 3 cases (13%) with chronic pancreatitis. In view of these findings, the relationship between anomalous arrangement of pancreatico-biliary duct and pancreatitis was clinically investigated from various aspects. The subjects included a total of 23 cases of the anomalous arrangement of pancreatico-biliary duct. They consisted of 3 male cases and 20 female cases. According to Kimura's criteria, the anastomotic pattern was classified as typeI (pancreatic duct anatomotic type) in 11 cases and as type II (bile duct anatomotic type) in 12 cases. All 5 cases with complication of pancreatitis had a congenital biliary dilatation. Two patients who had acute pancreatitis were girls of 5 years and 14 years of age, respectively, and both were diagnosed as having the type I anastomotic pattern. Chronic pancreatitis was seen in 3 patients consisting of a 46-year-old woman, a 49-year-old woman and a 50-year-old man, in all of whom the anastomotic pattern was classified as type II. In these patients, the chronic pancreatitis was considered X-ray-positive pancreatolithiasis, mass forming pancreatitis and alcoholic pancreatitis, respectively. The results in these 5 patients showed that a complication of acute pancreatitis was seen more frequently in younger patients and took a relatively mild course, while chronic pancreatitis is a more frequent complication in patients having the type II anastomotic pattern. These findings suggest the presence of causal relationship between the development of pancreatitis and an anomalous arrangement of pancreaticobiliary duct.