A Case of Pancreaticobiliary Maljunction with Repeated Pancreatitis Accompanied by Intestinal Malrotation

Tsukuda Kazuhiko, Ohtsuka Hideo, Ishida Masaharu, Mizuma Masamichi, Nakagawa Kei, Hayashi Hiroki, Morikawa Takanori, Kume Kiyoshi, Omori Yuko, Masamune Atsushi, Furukawa Toru, Kamei Takashi, Unno Michiaki

doi:10.5833/jjgs.2020.0157

<p>The patient was a 22-year-old man who had undergone diamond anastomosis for congenital duodenal obstruction with intestinal malrotation in the neonatal period. He had suffered from recurrent pancreatitis since he was 20 years old. A detailed examination showed that the pancreatic duct joined the dilated and bent common bile duct outside the duodenal wall, and pancreaticobiliary maljunction (hereinafter referred to as maljunction) was diagnosed. Stones were found in the dilated common bile duct just above the junction, but pancreatitis persisted after endoscopic removal of the stones. The anatomical abnormality of the junction of the dilated bile duct and pancreatic duct at the head of the pancreas was suspected to be impairing outflow of pancreatic juice, as a cause of pancreatitis. Subtotal stomach-preserving pancreaticoduodenectomy was performed because removal of the obstruction by extrahepatic bile duct resection was thought to be difficult. Congenital duodenal obstruction may be associated with annular pancreas, pancreas divisum, and maljunction, and has been pointed out as a cause of pancreaticobiliary complications over a long period after surgery. Extrahepatic bile duct resection is the standard treatment for maljunction, but pancreaticoduodenectomy may be an option in a case in which it is difficult to remove the intrapancreatic bile duct without leaving a remnant.</p>

A Case of Pancreaticobiliary Maljunction with Repeated Pancreatitis Accompanied by Intestinal Malrotation

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