Pancreatic disorders associated with anomalous pancreaticobiliary junction

Background. The aim of this study was to establish an optimal management st rategy for pancreatic disorders associated with anomalous pancreaticobiliar y junction (APBJ). Methods. In 64 adult surgical cases of APBJ (common, channel 15 mm or longe r) (43 with and 21 without choledochal cyst), associated pancreatic disorde rs, pancreatographic results, and treatment outcomes were analyzed. Results, Of 64 patients, 56 had pancreatobiliary symptoms. Twenty-four pati ents (38%) had pancreatic disorders: acute pancreatitis (n = 20), chronic c alcifying pancreatitis (n = 2), and pancreatic carcinoma (n = 2). Twenty pa tients (31%) had abnormal pancreatograms. The incidence of acute pancreatit is war significantly higher in patients with an abnormal pancreatogram, par ticularly dilatation, protein plugs or stones of the common channel or main pancreatic duct, and coexisting pancreatic ductal anomaly. All patients wi th choledochal cyst underwent cyst excision and hepaticojejunostomy. Eleven patients without choledochal cyst or pancreatobiliary carcinoma underwent cholecystectomy alone. Protein plugs and pancreatic stones were extracted t hrough the bile duct stump or by sphincterotomy. No patients experienced pa ncreatitis during a mean postoperative follow-up of 6.7 years. Conclusions, In managing APBJ, attention should be paid to the possibility of associated pancreatic disorders and an abnormal pancreatogram. APBJ with choledochal cyst requires cyst excision. Cholecystectomy alone may be adeq uate for APBJ without cyst.