CONGENITAL-ABNORMALITIES OF THE PANCREAS AND BILIARY TREE IN ADULTS

Congenital abnormalities of the pancreaticobiliary tree may go undetec ted until adulthood. In adult patients with persistent and unexplained signs and symptoms, such as cholangitis, pancreatitis, jaundice, recu rrent abdominal pain, and nausea and vomiting, a congenital anomaly of the pancreatic or bile duct must be considered and a low threshold fo r performing cholangiopancreatography is recommended. The most common congenital pancreaticobiliary abnormalities seen in adults are choledo chal cyst, anomalous junction of the pancreatic and common bile ducts, aberrant biliary ducts, and pancreas divisum, with the following enti ties being more rarely seen: choledochoceles, multiple communicating i ntra- and extrahepatic duct cysts, Caroli disease, pancreaticobiliary abnormalities associated with situs anomalies, annular pancreas, and a berrant pancreatic ducts associated with enteric duplication cysts. Ch olangiopancreatography allows confirmation of diagnosis and may demons trate associated abnormalities such as choledocholithiasis or tumor. R ecognition of congenital anomalies may aid in surgical planning and pr event inadvertent ductal injury. Although congenital pancreaticobiliar y abnormalities are relatively uncommon, the increased prevalence of c holangitis, gallstones, and cholangiocarcinoma seen with the various t ypes of biliary cystic disease and junctional anomalies and the increa sed association of pancreatitis seen with pancreatic anomalies make re cognition of variant anatomy clinically important.