Advertisement

Separate pancreatic ducts draining into a type IV choledochal cyst: simultaneous anatomical variants in a child suffering from cholelithiasis and acute pancreatitis

  • Giuseppe CiceroEmail author
  • Alfredo Blandino
  • Giorgio Ascenti
  • Silvio Mazziotti
Anatomic Variations
  • 2 Downloads

Abstract

The biliary tree and the pancreatic ducts originate from different buds of the primitive foregut. A plethora of anatomical variants and congenital anomalies have been described for both the biliary and the pancreatic duct systems, although they are usually asymptomatic. However, in some cases, these abnormalities can lead to serious clinical scenarios, especially when involving the biliopancreatic junction, with consequent mixing and reflux of the two different juices. To the best of our knowledge, we present the first case of pancreas divisum ducts draining into a choledochal cyst, with the lower third of the choledochus configuring a common biliopancreatic duct, in a child suffering from cholelithiasis and acute pancreatitis.

Keywords

Choledochal cyst Pancreas Divisum Magnetic resonance cholangiopancreatography 

Notes

Author contributions

GC: Manuscript writing; AB: Image evaluation and project conception; GA: Co-writing the manuscript; SM: Review of the manuscript and final version acceptance.

Funding

The authors did not receive any funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Ando H (2010) Embryology of the biliary tract. Dig Surg 27(2):87–89CrossRefGoogle Scholar
  2. 2.
    Babbitt DP (1969) Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb. Ann Radiol (Paris) 12:231–240Google Scholar
  3. 3.
    Borghei P, Sokhandon F, Shirkhoda A, Morgan DE (2013) Anomalies, anatomic variants, and sources of diagnostic pitfalls in pancreatic imaging. Radiology 266(1):28–36CrossRefGoogle Scholar
  4. 4.
    D’Angelo T, Racchiusa S, Mazziotti S, Cicero G (2017) Magnetic resonance (MR) cholangiopancreatography demonstration of the cystic duct entering the right hepatic duct. Am J Case Rep 18:242–245CrossRefGoogle Scholar
  5. 5.
    Gonoi W, Akai H, Hagiwara K, Akahane M, Hayashi N, Maeda E, Yoshikawa T, Tada M, Uno K, Ohtsu H, Koike K, Ohtomo K (2011) Pancreas divisum as a predisposing factor for chronic and recurrent idiopathic pancreatitis: initial in vivo survey. Gut 60(8):1103–1108CrossRefGoogle Scholar
  6. 6.
    Kamisawa T, Koike M, Okamoto A (1999) Embryology of the pancreatic duct system. Digestion 60(2):161–165CrossRefGoogle Scholar
  7. 7.
    Kim R, Marfil-Garza BA, Shapiro AMJ, Kin T (2018) Circumportal pancreas accompanied with pancreas divisum in a deceased donor for islet transplantation. Surg Radiol Anat 40(11):1323–1325CrossRefGoogle Scholar
  8. 8.
    Le Roy B, Gagnière J, Filaire L, Fontarensky M, Hordonneau C, Buc E (2016) Pancreaticobiliary maljunction and choledochal cysts: from embryogenesis to therapeutics aspects. Surg Radiol Anat 38(9):1053–1060CrossRefGoogle Scholar
  9. 9.
    Liao Z, Gao R, Wang W, Ye Z, Lai XW, Wang XT, Hu LH, Li ZS (2009) A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum. Endoscopy 41(5):439–444CrossRefGoogle Scholar
  10. 10.
    Makin E, Davenport M (2012) Understanding choledochal malformation. Arch Dis Child 97(1):69–72CrossRefGoogle Scholar
  11. 11.
    Singham J, Yoshida EM, Scudamore CH (2009) Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg 52(5):434–440PubMedPubMedCentralGoogle Scholar
  12. 12.
    Suzuki M, Sai JK, Shimizu T (2014) Acute pancreatitis in children and adolescents. World J Gastrointest Pathophysiol 5(4):416–426CrossRefGoogle Scholar
  13. 13.
    Todani T, Watanabe Y, Toki A, Morotomi Y (2003) Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepatobiliary Pancreat Surg 10(5):340–344CrossRefGoogle Scholar
  14. 14.
    Türkvatan A, Erden A, Türkoğlu MA, Yener Ö (2013) Congenital variants and anomalies of the pancreas and pancreatic duct: imaging by magnetic resonance cholangiopancreaticography and multidetector computed tomography. Korean J Radiol 14(6):905–913CrossRefGoogle Scholar
  15. 15.
    Yu J, Turner MA, Fulcher AS, Halvorsen RA (2006) Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: part 2, Pancreatic duct and pancreas. AJR Am J Roentgenol 187(6):1544–1553CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional ImagingUniversity of MessinaMessinaItaly

Personalised recommendations