Anomalous arrangement of the pancreatobiliary ductal system
in patients with a choledochal cyst
Takuji Todani, Yasuhiro Watanabe, Tadashi Fujii, Sadashige
Uemura
Am J Surg 147: 672-676, 1984
An anomalous arrangement of the pancreatobiliary ductal
system is usually observed in patients with a congenital choledochal cyst
and is represented by a long common channel distal to the pancreatobiliary
junction. According to the angle of the pancreatobiliary junction, anomalous
junctions can be classified into four groups, right angle, acute angle,
complex union, and normal union (presented here in the order of their incidence).
The right-angle type tends to have cystic dilatation of the choledochus,
whereas the acute-angle type generally has cylindrical dilatation. However,
the grade and length of the stenosis on the distal part of the choledochus
tend to determine the type of choledochal cyst. Cystic dilatation is usually
observed in patients with high-grade and long stenosis, whereas cylindrical
dilatation is seen in those with low-grade and short stenosis. Patients
with an acute angle junction seem to only suffer from abdominal pain, and
those in the complex union group tend to have jaundice and an abdominal
tumor. A high amylase level in the bile within the cyst is observed frequently.
In patients with obstructive jaundice, however, the amylase level is usually
not elevated, because pancreatic juice cannot enter the choledochus.
Return