Diagnosis of the anomalous arrangement of pancreaticobiliary ductal system unaccomanied by a dilatation of the bile duct can be difficult, and its treatment is controversial, some favoring only a follow up after the treatment for the concurrent gallbladder lesion and others advocating a dissociative operation.
We recently experienced a case in which non-calculous suppurative cholangitis and obstructive jaundice occurred respectively at 5 months and 12 months after cholecystectomy, and the anomalous arrangement of pancreaticobiliary ductal system then diagnosed was successfully treated by dissociative operation.
In this case the common bile duct was 8 mm in external diameter and the common channel was 10 mm in length. However, the common bile duct joined the pancreatic duct to form an inverted T, cholangiography readily visualized the pancreatic duct, and the biliary amylase level was elevated, from which the intermediate type of anomalous arrangement of pancreaticobiliary ductal system, proposed by Komi, was diagnosed.
Dissociative operation is indicated in the anomalous arrangement of pancreaticobiliary ductal system unaccompanied by bile duct dilatation, if such symptoms as cholangitis, pancreatitis and obstructive jaundice occur repeatedly.