Acute pancreatitis and a long common channel.
BACKGROUND
As sphincter action does not functionally affect the union in pancreaticobiliary maljunction (PBM), two-way regurgitation occurs. We investigated the features of acute pancreatitis associated with patients displaying a long common channel.


METHODS
We reviewed 3210 endoscopic retrograde cholangiopancreatograms. PBM was diagnosed in 107 patients with a long common channel in which communication between the pancreatic and bile duct was maintained even during sphincter contraction. High confluence of pancreaticobiliary ducts (HCPBD) was diagnosed in 60 patients with a common channel >or=6 mm long in which communication between the two ducts was occluded with sphincter contraction.


RESULTS
Of patients with PBM, four had acute pancreatitis. Etiology of acute pancreatitis in the two patients was suspected to involve impaction in a long common channel. Of patients with HCPBD, 17 displayed acute pancreatitis. Three patients had a history of excessive alcohol intake and 10 patients were associated with choledocholithiasis or cholecystitis. The remaining four patients had no history of them.


CONCLUSIONS
Acute pancreatitis occurs in 13% of patients with a long common channel. Obstruction of a long common channel by stones easily induces bile flow into the pancreas. Even if no obstruction is present, biliopancreatic reflux induces acute pancreatitis in some patients.
Kamisawa
Terumi
T
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Tokyo, 113-8677, Japan. kamisawa@cick.jp
Tu
Yuyang
Y
Nakajima
Hitoshi
H
Egawa
Naoto
N
Tsuruta
Kouji
K
Okamoto
Atsutake
A
Matsukawa
Masakatsu
M
D000208:Acute Disease; D001652:Bile Ducts / Q000002:abnormalities / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D010183:Pancreatic Ducts / Q000002:abnormalities / Q000473:pathology*; D010195:Pancreatitis / Q000473:pathology* / Q000503:physiopathology