Anomalous biliary drainage associated with pancreaticobiliary maljunction and nondilatation of the common bile duct

Ectopic pancreaticobiliary drainage accompanied by proximal jejunal adenoma: A case report

A patient with obstructive jaundice was examined by multidetector row helical computed tomography (MDCT) and magnetic resonance imaging (MRI), and his common bile duct was observed to be leading into the distal portion of the horizontal duodenum with a pancreaticobiliary union outside the duodenal wall. A mass was also found in the proximal jejunum. All the above findings were confirmed by subsequent surgery, thus contrast-enhanced MDCT and MRI with appropriate image post-processing could provide non-invasive and accurate information regarding anatomy and lesions of the pancreaticobiliary duct and duodenal union, which may improve the feasibility of surgery and reduce postoperative complications.

Pancreaticobiliary maljunction without bile duct dilatation in children: distinction from choledochal cyst

OBJECTIVES

Pancreaticobiliary maljunction without bile duct dilatation (nondilated type) is rare in children, and its definition remains unclear. There is controversy over treatment between pediatric and adult patients. We reevaluated our previous definition of the nondilated type in children (common bile duct diameter <or=6 mm on cholangiography).

PATIENTS AND METHODS

Of 150 children with pancreaticobiliary maljunction, 14 fulfilled the definition of the nondilated type. Clinical and cholangiographic findings were reviewed and compared with cholangiograms of 17 children without biliary diseases (controls). The age-related normal range of the choledochal diameter was defined in combination with previous data.

RESULTS

All of the patients had symptoms and signs similar to those of choledochal cysts. Cholangiographic features of choledochal cysts were detected in all of the patients (dilated common channel, 8; distal bile duct stenosis, 5; dilated cystic duct, 4; filling defect in the common channel, 8). The choledochal diameter in control children increased with age. Only 4 patients (29%) had a choledochal caliber within the normal range.

CONCLUSIONS

Most pediatric cases reported as the nondilated type are slightly dilated (forme fruste) choledochal cysts and differ from the nondilated type seen in adults. The nondilated type in children should be defined on the basis of the age-related choledochal diameter.