Anomalous pancreaticobiliary duct junction presenting as benign biliary stricture

Area of Science:

• Gastroenterology and Hepatology
• Surgical Anatomy
• Diagnostic Imaging

Background:

• Anomalous pancreaticobiliary duct junction (APBDJ) is a congenital anomaly where pancreatic and bile ducts join outside the duodenal wall.
• This malunion creates a long common channel, facilitating reflux of pancreatic and biliary secretions, potentially leading to complications like pancreatitis and malignancy.
• Clinical manifestations are diverse, emphasizing the need for accurate diagnosis and timely intervention.

Purpose of the Study:

• To present two cases of type III-C3 anomalous pancreaticobiliary duct junction.
• To illustrate the diagnostic process using imaging and ERCP.
• To discuss the differential management strategies for APBDJ.

Main Methods:

• Case report of two female patients presenting with abdominal pain, jaundice, and fever.
• Diagnostic workup included imaging and endoscopic retrograde cholangiopancreatography (ERCP).
• Management involved ERCP with hepaticojejunostomy for one patient and conservative treatment for the other.

Main Results:

• Both patients were diagnosed with type III-C3 APBDJ based on imaging and ERCP findings, including two communicating papillae and common bile duct dilatation.
• One patient underwent successful ERCP and hepaticojejunostomy.
• The second patient opted for conservative management without intervention.

Conclusions:

• Type III-C3 anomalous pancreaticobiliary duct junction requires careful diagnosis through combined imaging and endoscopic evaluation.
• Management strategies for APBDJ should be individualized, ranging from surgical intervention to conservative approaches based on patient factors and preferences.