The variable appearance of distal common bile duct stenosis in chronic pancreatitis

Cholangiograms of 15 patients with stenosis of distal portion of common bile duct due to chronic alcoholic pancreatitis were critically evaluated for stricture shape, length, and maximal diameter of the common bile duct. In these cholangiograms, different shapes of strictured segments were present, including the smooth tapering variety in eight, "funnel shape" in three, and "rat tail," "bent knee," "hourglass," and complete obstruction in one case each. The length of strictured segment ranged from 16 to 57 mm with a mean (+/- S.E.) of 40.7 +/- 4.1 mm. The mean (+/- S.E.) maximal diameter of the dilated portion of common bile duct was 18.9 +/- 1.3 mm with a range of 13-28 mm. There is a wide variety in the shape and length of the stenotic segments of the distal common bile duct in chronic alcoholic pancreatitis. Moreover, a particular radiologic configuration of common bile duct stricture is not helpful in predicting the nature of the underlying process in this group of patients.