A CASE OF ANOMALOUS ARRANGEMENT OF THE PANCREATICOBILIARY DUCTAL SYSTEM DEMONSTRATED BY INTRADUCTAL ULTRASONOGRAPHY

A 55-yr-old female was hospitalized with epigastric pain. Conventional ultrasonography revealed marked dilation of the common bile duct (CBD ). Endoscopic retrograde cholangiopancreatography showed fusiform dila tion of the CBD. The common channel of the pancreatic duct and choledo chus was 20 mm long. A diagnosis of congenital choledochal dilation ac companied by anomalous arrangement of the pancreaticobiliary ductal sy stem (AAPBDS) was made. Intraductal ultrasonography (IDUS) was perform ed. IDUS demonstrated the union of the pancreatic duct and choledochus within the pancreatic parenchyma. This meant that the union existed o utside the duodenal wall, confirming the diagnosis of AAPBDS. Although endoscopic retrograde cholangiopancreatography alone could show the m aljunction in this case, simultaneous IDUS will be useful in making an accurate diagnosis of AAPBDS.