New insight into bile flow dynamics in anomalous arrangement of the pancreaticobiliary duct.
BACKGROUND
In an anomalous arrangement of the pancreaticobiliary duct (AAPBD), two-way regurgitation, including pancreaticobiliary reflux and biliopancreatic reflux (BPR), might occur. Although pancreaticobiliary reflux has been shown by high levels of pancreatic enzymes in bile, there have been few reports of clinical evidence of BPR in AAPBD. Recently, spiral computed tomography combined with intravenous infusion cholangiography (IVC-SCT) has been reported to be useful for visualizing the biliary anatomy, which may allow a new insight into bile flow dynamics in AAPBD.


METHODS
Fifteen paediatric patients with AAPBD were examined before operation using both IVC-SCT and endoscopic retrograde cholangiopancreatography. Visualization of the main pancreatic duct on IVC-SCT defined the presence of BPR. Blood samples were also analysed when the initial symptom was strongly present.


RESULTS
BPR was observed in six of 15 patients. Pancreatic enlargement and hyperamylasaemia were significantly more frequent in patients without BPR than in those with BPR. Levels of enzyme markers of cholestasis were also higher in the former group.


CONCLUSIONS
The present study, using IVC-SCT, has identified clinical evidence of BPR in AAPBD. Further studies are necessary to determine the correlation between BPR and clinical manifestations.
Fumino
S
S
Division of Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-0841, Japan. fumin@koto.kpu-m.ac.jp
Tokiwa
K
K
Katoh
T
T
Ono
S
S
Iwai
N
N
D000293:Adolescent; D000681:Amylases / Q000097:blood; D001646:Bile / Q000502:physiology*; D001652:Bile Ducts / Q000002:abnormalities*; D001655:Bile Reflux / Q000000981:diagnostic imaging / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods
D000681:Amylases