Cystic duct insertion at ampulla and acute recurrent pancreatitis

Variant anatomy of the biliary system as a cause of pancreatic and peri-ampullary cancers

“…This increased pressure, in turn, may lead to reflux into the pancreatic ducts as well as the peri-biliary glands thus initiating the carcinogenetic process. It was reported that low union may also lead to pancreatitis, 21,26,27 and in fact, may be the mechanism by which low union participates in the development of paraduodenal (groove) pancreatitis seen in 40% of cases in this study.…”

“…The literature on low union is surprisingly limited. 21,22 It has been implicated in cholelithiasis/choledocholithiasis, 23 -25 pancreatitis 21,26,27 and gallbladder cancer 28 but its potential role in peri-ampullary cancers has not been systematically analyzed. In fact, the data on its frequency is also scarce.…”

“…1) that is seen in 90% of the population. This variation, seen in estimated 10% of the population, has attracted limited attention in the literature, 21,22 with some reports linking it to a higher frequency of cholelithiasis/choledocholithiasis, 23 -25 pancreatitis 21,26,27 and gallbladder cancer. 28 To our knowledge, there is no data analyzing the association of this anatomic variation of the pancreatobiliary tract with any pancreatobiliary disorders or neoplasms.…”

An exceedingly rare case of separated drainage of the cystic duct, the common bile duct and the main pancreatic duct documented on magnetic resonance cholangiopancreatography

“…A medial and extremely low (intraduodenal) insertion of CD is an exceedingly rare nding, with percentages ranging from 1.66% in cadaveric studies [5] to 2% in cholangiopancreatographic studies [6], and only very few cases reported in the literature. Moreover, evidence of this singular con guration is supported only by endoscopic retrograde cholangiopancreatography (ERCP) images [1,4]. Here, we report a unique case of medial and extremely low (intraduodenal) insertion of CD and, to the best of the Authors' knowledge, the very rst report of this exceptionally rare anatomic anomaly on magnetic resonance cholangiopancreatography (MRCP).…”

“…The signi cance of a low CD union was rst described by Eisendrath in 1918 who noted that such anatomy might predispose to inadvertent bile duct injury during cholecystectomy [1]. Reports concerning the further clinical signi cance of this anatomic anomaly are relatively rare, but they observed an association with gallstone pancreatitis, Mirrizi syndrome, gallbladder cancer, and cystic dilatation of the biliary duct [2].…”