The Role of Anatomical Features and Variations of the Pancreaticobiliary Junction in the Etiology of Acute Biliary Pancreatitis

Abstract

Objective: Gallstone disease is among the most common known causes of acute pancreatitis. In our study, we examined the role of the length-diameter of the choledochus, the Wirsung diameter and the angle of the choledochal-Wirsung junction, which may cause obstruction in the etiology of acute pancreatitis. We aimed to recommend prophylactic cholecystectomy for asymptomatic patients whose anatomical features may affect acute attacks and to prevent attacks. Materials and Methods:Patients who were diagnosed with uncomplicated cholelithiasis and patients who were diagnosed with acute biliary pancreatitis and admitted to our clinic between January 2019 and August 2022 were retrospectively examined. Conservative follow-up of patients with uncomplicated cholelithiasis continued. Patients with acute biliary pancreatitis were treated with treatments recommended by current guidelines. In the MRCP imaging performed in our hospital, the length-diameter, Wirsung diameter and junction angle with the common bile duct were measured and compared by a single radiologist.Results: A total of 149 patients were included in the study. Among the groups, the age of the control group was found to be significantly lower (p<0.001). There was no significant difference between the groups in terms of common bile duct diameter or Wirsung diameter. Although the common bile duct length parameter was found to be high in patients with acute pancreatitis (p=0.013), the common bile duct-Wirsung junction angle was significantly lower (p=0.036). Conclusion:In our study, a high Choledoc length increased the risk of acute biliary pancreatitis, and a low angle between the Choledoc and Wirsung increased the risk of acute biliary pancreatitis.