A Case of Pancreaticobiliary Maljunction Without Bile Duct Dilatation in a Child With a Common Bile Duct of Normal Diameter

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  • 正常な総胆管径を呈した膵・胆管合流異常症の1幼児例
  • 症例報告 正常な総胆管径を呈した膵・胆管合流異常症の1幼児例
  • ショウレイ ホウコク セイジョウ ナ ソウタンカンケイ オ テイシタ スイ タンカン ゴウリュウ イジョウショウ ノ 1 ヨウジレイ

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An infant girl, one year and ten months of age, was experiencing vomiting and stomachaches and was transferred to our hospital due to liver dysfunction and a high blood amylase level. The abdominal echogram showed no abnormalities, but the CT scan showed a dilated main pancreatic duct, 5mm in diameter. MRCP revealed that the main pancreatic duct emptied into the duct of Santorini, but the duct of Wirsung could not be detected. ERCP revealed that the common bile duct was normal in diameter, 3mm, and that it joined the common channel. We diagnosed the patient as having pancreaticobiliary maljunction (PBMJ) without bile duct dilatation. The operative contrast medium in the bile duct showed that the common bile duct, which was 3mm in diameter, joined with the common channel midway down the pancreatic duct and that both the duct of Santorini and of Wirsung opened to the duodenum. After excising the extrahepatic bile duct, we cut the anterior and the posterior walls of the residual bile duct longitudinally because of the wide anastomosis, and Roux-en Y hepaticojejunostomy was performed. Our case is very rare, in that her common bile duct had a normal diameter in spite of PBMJ. PBMJ without bile duct dilatation is a high-risk factor of gallbladder cancer, so we are still unable to decide which therapy, cholecystectomy or reconstructive surgery, is appropriate for this disease. Many child cases of PBMJ without bile duct dilatation develop pancreatitis, as our case has, so she underwent reconstructive surgery.

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