Frequency of bile duct confluence variations in subjects with pancreas divisum: an analysis of MRCP findings

Abstract

ongenital anomalies of the pancreatic duct may remain undiagnosed until adulthood and they are often diagnosed incidentally. Pancreas divisum (PD) is the most common congenital anomaly of the pancreas which occurs from a failure of ventral and dorsal bud fusion (1, 2). It accounts for about 4%-14% of the population at autopsy series, and approximately 9% are detected using magnetic resonance cholangiopancreatography (MRCP) (3). In PD, the ventral (Wirsung) duct opens into the major papilla without merging with the dorsal (Santorini) duct. The dorsal duct, which opens into the minor papilla, is responsible for the majority of the drainage from the pancreas. The clinical importance of PD is not clear. Most patients are asymptomatic, whereas in some patients, PD may cause recurrent pancreatitis due to lack of adequate drainage into duodenum via minor papilla (3, 4). Of patients with idiopathic recurrent pancreatitis, 12%-26% have PD (5). There are various type of examinations to evaluate the pancreaticobiliary system; however, MRCP has been shown to be an effective noninvasive imaging modality for the visualization of the biliary tree and pancreatic duct. Bret et al. (6) reported an accuracy rate of 100% in the diagnosis of PD using MRCP (6).Laparoscopic cholecystectomy, transplantation surgery, hepatic resection, and tumor surgery are the most common hepatobiliary surgeries in which complications related to the bile duct variations comprise one of the most common reasons for morbidity and mortality. PURPOSEWe aimed to evaluate the frequency of bile duct branching pattern variations at the hepatic confluence in patients with pancreas divisum (PD). METHODSA search was performed through the hospital database using the keyword "pancreas divisum" to identify patients. The magnetic resonance cholangiopancreatography (MRCP) images of 137 patients who were diagnosed with PD between August 2011 and November 2016 were retrospectively analyzed for the presence of bile duct variations. A control group of 137 patients without PD was established among patients investigated during the same period. Variations of the biliary tract were grouped into seven types according to the McSweeney et al. classification. RESULTSBiliary tract variations were detected in 103 of a total of 274 patients. Fifty-eight PD patients (42.3%) and 45 control patients (32.8%) had bile duct variation at the hepatic confluence level. The patients with PD were more likely to have biliary tract variation compared with the control group; however, it was not statistically significant (P = 0.105). The most common variation in PD patients was type 3a variation (16.8%). CONCLUSIONMRCP studies showed atypical bile duct confluence pattern in nearly half of both PD patients and controls. There was no statistically significant difference in the frequency of anatomic variations at bile duct confluence in patients with PD versus those without PD. Derivation of these structures from different outpouchings in early embryological life may explain this insignificant differ...

Prevalence of Different Hepatobiliary Tree Variants on Magnetic Resonance Cholangiopancreatography in Patients Visiting a Tertiary Care Teaching Hospital in Karachi

“…With the expanding pattern in interventional radiological methods and surgical techniques, such as image-guided interventional biliary drainage procedures, laparoscopic cholecystectomies, tumor surgery and liver resection alongside liver transplantation, precise information of these anatomic variations is of considerable clinical pertinence [ 2 , 4 , 5 , 7 , 8 ], as perioperative biliary complications comprise one of the most frequently encountered reasons for morbidity and mortality [ 1 , 2 , 9 , 10 ].…”

“…Many studies have been conducted to estimate the prevalence of different biliary tree variants as described by Nayman et al [ 2 ], Pesce et al [ 3 ], Uysal et al [ 6 ], and Gursoy et al [ 7 ], but so far local data remain scarce. The objective of this study is to determine the prevalence of anatomical variants of the biliary tree in our population using the MRCP technique at a tertiary care hospital.…”

Biliary anatomy and pancreatic duct variations: A cross-sectional study

“…[ 6 7 ] There is a spectrum of variations in the course of the pancreatic duct. [ 8 9 ] The most common course is a descending course that occurs in about 50% of cases. [ 8 ] Other types of possible anatomy include sigmoid, vertical, and loop configurations.…”

“…[ 8 ] Other types of possible anatomy include sigmoid, vertical, and loop configurations. [ 8 9 ] Ductal configuration is also subjected to variations. The most common configuration is a bifid duct with the dominant duct of Wirsung (major pancreatic duct), which occurs in 60% of cases.…”

“…[ 11 ] However, some may predispose to pathologic conditions. [ 9 11 12 ] Hepatobiliary surgery includes transplant, tumor resection, and laparoscopic biliary surgery, which are all prone to complications. [ 10 ] Anatomical variations in the biliary tree are expected in 42% of the population.…”