A Case Report of Anomalous Pancreaticobiliary Junction with Severe Acute Pancreatitis and Gallbladder Cancer

Hiroaki Watanabe, Shoichiro Sumi, Takayuki Urushihata, Shinji Iwasaki, Susumu Sasaki, Seiji Yano, Yoshinori Nio, Katsuhiro Tamura

First Department of Surgery, Shimane Medical University

A 63-year-old woman with a history of severe acute pancreatitis was admitted to our hospital for the treatment for a gallbladder stone and a pseudocyst of the pancreas. Abdominal computed tomography and ultrasonography showed an elevated lesion in the fundus of the gallbladder with many gallstones. Endoscopic retrograde cholangiopancreatography revealed an anomalous pancreaticobiliary junction with about 4 cm of the common canal without dilatation of the common bile duct. Resection of the gallbladder and the common bile duct with Roux-en Y hepatidocho-jejunostomy were performed. In the gallbladder were 15 small gallstones and many elevated lesions, which were pathologically diagnosed as papillary adenocarcinoma of the gallbladder intraoperatively. Although severe acute pancreatitis with an anomalous pancreaticobiliary junction is rarely reported, some additional factors such as gallstones might have made the pancreatitis severe. Postoperative magnetic resonance cholangiopancreatography (MRCP) in this case clearly showed the anomalous junction, suggesting that noninvasive MRCP is very useful for the diagnosis of this anomaly especially when pancreatitis with it is associated.

Key words
anomalous pancreaticobiliary junction, severe acute pancreatitis, gallbladder cancer

Reprint requests
Shoichiro Sumi First Department of Surgery, Shimane Medical University
89-1 Enya-cho, Izumo, 693-8051 JAPAN

Accepted
September 16, 1998

To read the PDF file you will need Abobe Reader installed on your computer.