Pancreatic ductal morphological pattern and dilatation in postoperative abdominal pain in patients with congenital choledochal cyst: An analysis of postoperative pancreatograms

Background: Postoperative abdominal pain associated with pancreatitis has b een reported as a pancreas-associated complication after total biliary exci sion. The aim of the present study was to determine pancreatic ductal patte rns in the head of the pancreas and evaluate pancreatic ductal dilatation i n patients presenting with postoperative abdominal pain after radical bilia ry excision for congenital choledochal cyst. Methods: Postoperative endosco pic retrograde pancreatography (ERP) was performed in a total of 38 patient s (27 female and 11 male) with a history of postoperative abdominal pain or an increase in serum and urinary amylase on laboratory analysis. Pancreati c ductal configuration and ductal dilatation were determined. Results: Panc reatic configurations included the usual type (n = 20), ansa pancreatica ty pe (n = 11), loop type (n = 5, and divisum type (n = 2). Dilatation of the pancreatic duct was observed in 34 patients. The common channel was dilated in 29 patients. Mild postoperative pancreatitis occurred in 4 patients in the long term. Protein plugs were observed in the dilated pancreatic dust. Conclusions: Pancreatic ductal morphological pattern and ductal dilatation, possibly caused by long-standing stagnation of the pancreatic juice, may b e associated with postoperative abdominal pain and pancreatitis in congenit al choledochal cyst.