Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding author:
Myung Hwan Kim,
ABSTRACT
Background and Study Aims: Choledochal cyst is a congenital dilatation of the bile duct and frequently associated with anomalous union of pancreaticobiliary duct (AUPBD). AUPBD has been regarded to be the etiologic factor of choledochal cyst. However, the clinical significance of AUPBD in patients with choledochal cyst has not been clearly defined. The aims of our study were to compare the clinical features of patients with choledochal cyst according to the presence or absence of AUPBD, and to clarify the significance of AUPBD in choledochal cyst patients. Patients and Methods: From August 1990 to December 1996, 52 cases were diagnosed as having choledochal cyst out of 5,037 ERCP referrals. In 44 of 52 cases, the pancreaticobiliary junction was clearly visualized on cholangiopancreatography. We divided these cases into those associated with AUPBD (n=28, AUPBD-present group) and those without (n=16, AUPBD-absent group). Clinical features were compared between two groups. Furthermore, in AUPBD-present group, clinical data were also analyzed according to Kimura’s classification of AUPBD. Results: AUPBD was associated with choledochal cyst in 28 (64%) cases. According to Todani’s classification of choledochal cyst, AUPBD was found only in type I and IV cases. The incidence of gallstone disease in AUPBD-present group did not differ from that in AUPBD-absent group, while acute inflammation occurred more frequently in AUPBD-present (26/28, 93%) than in AUPBD-absent group (5/16, 31%)(p<0.01). Carcinoma developed only in AUPBD-present group (9/28, 32%), more often than in AUPBD-absent group (0/16, 0%)(p<0.05). Pancreatic disorders (i.e. pancreatic stone, pancreatitis, or pancreatic cancer) occurred in 12 of 28 cases in AUPBD-present group (43%), while only in 1 of 16 cases in AUPBD-absent group (6%)(p<0.05). Conclusion: AUPBD associated with choledochal cyst may have implication not only as a possible etiologic factor but also as an important factor that may affect the clinical course, surgical planning, and prognosis. In cases with choledochal cyst, we should make an effort to evaluate the presence of AUPBD.
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