ANOMALOUS PANCREATICOBILIARY DUCTAL UNION WITH CYSTIC DILATATION OF THE BILE-DUCT

We report, in an adult, an asymptomatic association between cystic dil atation of the bile duct (type IV A in Todani's classification) and an omalous pancreatico-biliary ductal union (APBD) with stones in a long common channel. In APBD, the connection between the common bile duct a nd the main pancreatic duct is located outside the duodenal wall and i s therefore not under the influence of the sphincter of Boyden. An abn ormally long common channel is in excess of 15 mm. Two types of conver gence anomalies are defined according to whether the bile duct opens i nto the main pancreatic duct (BP) or the main pancreatic duct into the bile duct (PB). In APBD, there is probably a reverse pressure gradien t between the bile and pancreatic ducts, with regurgitation of pancrea tic juice into the bile duct, repeated attacks of cholangitis, stenosi s and cystic dilatation. A long common channel is associated with a hi gher incidence of carcinoma of the gall bladder or the bile duct.