title: Symptomatic pancreatic duct stones in the disconnected bile duct: A case series.
abstract: BACKGROUND
  Pancreaticobiliary maljunction (PBM) refers to the union of the pancreatic and biliary ducts outside of the duodenal wall. Patients are at increased risk of bile duct and gallbladder cancer, likely secondary to pancreatic juice refluxing into the biliary tree, and it is recommended that they undergo biliary diversion.
  
  
  METHODS
  This is a case series of all patients in our institution with PBM and bilioenteric anastomosis who presented with symptomatic pancreatic duct stones in a disconnected bile duct. IRB approval was obtained prior to the initiation of the study.
  
  
  RESULTS
  We describe eight cases of this finding. All patients underwent ERCP, with stones successfully removed from the disconnected bile duct in seven patients and from the pancreatic duct in one patient.
  
  
  CONCLUSIONS
  This novel finding has not been described in the medical literature, and may become more prevalent as more patients with PBM undergo bilioenteric anastomosis.
authors.affiliation: Division of Gastroenterology, University of Washington, Seattle, WA, United States.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Ende
authors.affiliation: Digestive Disease Institute at Virginia Mason Medical Center, Seattle, WA, United States.
authors.forename: Shayan
authors.initials: S
authors.lastname: Irani
authors.affiliation: Digestive Disease Institute at Virginia Mason Medical Center, Seattle, WA, United States. Electronic address: Richard.Kozarek@virginiamason.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001649:Bile Duct Diseases / Q000151:congenital / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017734:Bile Ducts, Extrahepatic / Q000002:abnormalities*; D002137:Calculi / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D006500:Hepatic Duct, Common / Q000601:surgery; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000151:congenital / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Chronic pancreatitis; Pancreatic stones; Pancreaticobiliary maljunction