Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer.
OBJECTIVE
Anomalous pancreaticobiliary junction is a rare anomaly but is a risk factor for primary carcinoma of the gallbladder. To define the relationship between anomalous pancreaticobiliary junction, especially if it is not associated with common bile duct dilatation, and gallbladder carcinoma, we retrospectively reviewed data of 126 patients with gallbladder carcinoma.


METHODS
All these patients had undergone direct cholangiography either by endoscopic retrograde cholangiopancreaticography or percutaneous transhepatic cholangiography.


RESULTS
Among 126 patients with gallbladder cancer, 23 patients (18.3%) exhibited anomalous pancreaticobiliary junction. Patients with anomalous pancreaticobiliary junction were younger (mean age: 54 +/- 9.1 years) than patients without anomalous pancreaticobiliary junction (mean age: 65 +/- 9.7 years). The incidence of gallstones in patients with anomalous pancreaticobiliary junction (17%) was significantly lower than in those without this anomaly (64%) (P < 0.01). Among the 23 patients with anomalous pancreaticobiliary junction, 12 patients (52%) had no bile duct dilatation and, 11 patients (48%) had bile duct dilatation in the form of fusiform or cylindrical dilatation. However, no cases with severe cystic dilatation were found. Patients of anomalous pancreaticobiliary junction without common bile duct dilatation had more advanced disease and poor prognosis than those with common bile duct dilatation.


CONCLUSIONS
The present study revealed that gallbladder cancer in the patients of anomalous pancreaticobiliary junction without common bile duct dilatation was diagnosed at advanced stage and the prognosis was very poor. Therefore, if a minor abnormality is detected in the wall of acalculous gallbladder on ultrasonography, direct cholangiography should be done to exclude this anomaly.
Elnemr
A
A
Department of Surgery II, School of Medicine Kanazawa University, Takara-machi 13-1, Kanazawa 920-0934, Japan.
Ohta
T
T
Kayahara
M
M
Kitagawa
H
H
Yoshimoto
K
K
Tani
T
T
Shimizu
K
K
Nishimura
G
G
Terada
T
T
Miwa
K
K
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000002:abnormalities*; D002763:Cholecystectomy; D003135:Common Bile Duct / Q000473:pathology; D004108:Dilatation, Pathologic; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities*; D012189:Retrospective Studies; D012307:Risk Factors