Two Cases of Anomalous Conjugation of the Pancreatico-Biliary Tract with Protein Plug Formation

Abstract

Two children with anomalous conjugation of the pancreatico-biliary tract with protein plug formation are presented. A 10-year-old girl was admitted to our hospiatl with severe pancreatitis and cholangitis and a 3-year-old girl was admitted with peritonitis due to perforation of the bule duct. The type of anomalous conjugation in both cases was type III-B according to the Ohi classification. Histologically, we found remarkable infiltration of inflammatory cells in their resected bile ducts. Protein plugs, which might have been formed by stasis of bile and pancreatic juice, were found in accessory pancreatic ducts near the accessory papilla. From these findings, it is suggested that when protein plugs entered into accessory papillae, acute massive reflux of bile and pancreatic juice brought on severe complications such as severe pancreatitis, cholangitis, and perforation of the bile duct.