A pathognomic study of the anomalous connection of pancreaticobiliary ducts

Abstract

Twenty-four cases of anomalous connection of the pancreaticobiliary ducts (ACPBD), encountered over a period of 4 years and 3 months, were clinically reviewed. Five cases (21%)presented with choledochal cysts. Six cases (25%) with spindle-like dilated type of common bile duct, and thirteen cases (54%) with non-dilated type of common bile duct, less than half of the cases were presented with symptoms and complications were limited to 4 gallbladder cancers (17%) and 1 gallstone cases (4%).
Ultrasonography (US) gave clues to diagnosis in as many as 23 of 24 patients, with findings including gallbladder wall thickening, dilatation of the common bile duct, and gallbladder polyps. The rate of detection of ACPBD itself was 96% with ERCP and 83% with EUS. While ERCP is clearly an excellent diagnostic tool, EUS is a more appropriate secondary test after US for procedural simplicity. In suspect cases, it is important that particular care be exercised to obtain a clear demonstration of connections of the pancreaticobiliary duct by EUS.