Anomalous pancreaticobiliary ductal union in tropical calcific pancreatitis.
BACKGROUND
Tropical calcific pancreatitis is unique to developing countries with of unknown origin.


OBJECTIVE
We evaluated the pattern of pancreaticobiliary ductal union in patients with tropical calcific pancreatitis.


METHODS
Twenty-one patients with tropical calcific pancreatitis were compared to 174 control subjects with no pancreaticobiliary disease and 35 patients with alcohol-induced chronic pancreatitis.


METHODS
Two experienced people, blinded to the results, evaluated the pattern of pancreaticobiliary ductal union. Pancreaticobiliary ductal unions were classified as: separate ducts (no union), a short common-channel (length less than 6 mm), a long common-channel (length ranging 6-15 mm) and anomalous pancreaticobiliary ductal union (length greater than 15 mm). Anomalous union was defined as P-B type when the pancreatic duct appeared to join the bile duct and B-P type when the bile duct appeared to join the pancreatic duct. Any disparities between the two investigators were sorted out by mutual discussion.


RESULTS
Pancreaticobiliary ductal union in tropical calcific pancreatitis patients as compared to those in the control group was as follows: separate ducts, 23.8% vs. 49.4% (P=0.036); a short common-channel, 4.8% vs. 28.7% (P=0.017); a long common channel, 33.3% vs. 18.4% (P=0.144) and anomalous pancreaticobiliary ductal union, 38.1% vs. 3.4% (P<0.001). The B-P pattern of anomalous pancreaticobiliary ductal union was more frequent in tropical calcific pancreatitis than in the control group but there was no statistical significance (P=0.103). The angle of the pancreaticobiliary ductal union in the tropical calcific pancreatitis group was 88.1 + or - 36.2 degrees as compared to 20.0 + or - 11.5 degrees in control group (P<0.001). Alcohol-induced chronic pancreatitis (No. 35) predominantly had either separate ducts (65.7%) or a short common channel (25.7%).


CONCLUSIONS
We concluded that patients with tropical calcific pancreatitis in Kashmir had anomalous pancreaticobiliary ductal union, predominantly of B-P type with a wide angle of ductal union more frequently. This may be related to the etiology of tropical calcific pancreatitis in such regions.
Khuroo
Naira Sultan
NS
Digestive Diseases Centre, Dr. Khuroo's Medical Clinic, Sector 1, Sher-e-Kashmir Colony, Qamarwari, Srinagar, Kashmir, India. khuroo@yahoo.com
Khuroo
Mohammad Sultan
MS
Khuroo
Mehnaaz Sultan
MS
D000293:Adolescent; D000328:Adult; D001652:Bile Ducts / Q000002:abnormalities; D001658:Biliary Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D010195:Pancreatitis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult