부췌관 배액술로 치료한 췌담관 합류 이상과 불완전 분할췌 동반 1예

An anomalous union of the pancreaticobiliary duct that was treated by drainage of the accessory ampulla

황종호;이상호;권효준;최홍석;김진만;장성원;최선희
Hwang, Jong-Ho;Lee, Sang-Ho;Kwon, Hyo-June;Choi, Hong-Suk;Kim, Jin-Man;Jang, Sung-Won;Choi, Sun-Hee

  • 발행 : 20070500

초록

저자들은 반복되는 췌장염의 과거력을 가진, 간헐적 상복통을 주소로 내원한 21세 여자 환자에서 내시경적 역행성 췌담관 조영술에서 담관 낭종이 없는 췌담관 합류이상이 불완전 분할췌와 동반된 것을 부췌관 배액술로 치료하였기에 문헌고찰과 함께 보고하는 바이다.

An anomalous union of the pancreaticobiliary duct is defined as a condition in which the junction between the common bile duct and the pancreatic duct is located outside the duodenal wall. Therefore, the sphincter of Oddi does not influence the junction; there is always communication between these ducts, and so pancreatic juice flows into the biliary tract through the communication, which may cause pancreaticobiliary diseases. Pancreas divisum is a congenital variant of the pancreatic ductal anatomy, and the mechanism is that the dorsal and ventral pancreatic buds fail to fuse during the gestation. We report here on a 21 year old woman who previously had suffered with recurrent pancreatitis, and an anomalous union of the pancreaticobiliary duct associated with the incomplete type of pancreas divisum was revealed by ERCP. She was treated with minor papilla sphincterotomy and stent insertion.

키워드

참고문헌

  1. Song HK, Kim MH, Myung SJ, Lee SK, Kim HJ, Yoo KS, Seo DW, Lee HJ, Lim BC, Min YI. Choledochal cyst associated with anomalous union of pancreaticobiliary duct has a more grave clinical course than choledochal cyst alone. Korean J Intern Med 14:1-8, 1999
  2. Kim MH, Kim HS, Chang HS, Chung SJ, Na JO, Kim HK, Shin ES, Kim YS, Myung SJ, Seo DW, Min YI. Endoscopic stenting with minor papilIa sphincterotomy in a patient with pancreas divisum and recurrent pancreatitis. Korean J Gastrointest Endosc 17:443-447, 1997
  3. Moon JH, Kim BS, Heo J, Kang DH, Song GA, Cho M, Yang US. A case of an anomalous union of the pancreatobiliary duct associated with incomplete pancreas divisum. Korean J Med 64:468-472, 2003
  4. Kim HJ, Kim MH, Lee SK, Seo DW, Kim YT, Lee DK, Song SY, Roe IH, Kim JH, Chung JB, Kim CD, Shim CS, Yoon YB, Yang US, Kang JK, Min YI. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointest Endosc 55:889-896, 2002 https://doi.org/10.1067/mge.2002.124635
  5. Sugiyama M, Atomi Y, Kuroda A. Pancreatic disorders associated with anomalous pancreaticobiliary junction. Surgery 126:492-497, 1999 https://doi.org/10.1016/S0039-6060(99)70090-5
  6. Mori K, Nagakawa T, Ohta T, Nakano T, Kayahara M, Kanno M, Ueno K, Izumi R, Miyazaki I. Association between gallbladder cancer with anomalous union of pancreaticobiliary ductal system. Hepatogastroenterology 40:56-60, 1993
  7. Sandoh N, Shirai Y, Hatakeyama K. Incidence of anomalous union of pancreaticobiliary ductal system in biliary cancer. Hepatogastroenterology 44:1580- 1583, 1997
  8. Nagata E, Sakai K, Kinoshita, Kobayashi Y. The relation between carcinoma of the gallbladder and an anomalous connection between the choledochus and the pancreatic duct. Ann Surg 202:182-190, 1985 https://doi.org/10.1097/00000658-198508000-00008
  9. Mori K, Akimoto R, Kanno M, Kamata T, Hirono Y, Matsumura A. Anomalous union of the pancreaticobiliary ductal system without dilatation of the common bile duct or tumor. Hepatogastroenterology 46:142-147, 1999
  10. Bernad JD, Sahel J, Giovannini M, Sarles M. Pancreas divisum is a probable cause of acute pancreatitis: a report of 137 cases. Pancreas 5:248- 254, 1990 https://doi.org/10.1097/00006676-199005000-00002
  11. Tulassay Z, Papp J. New clinical aspects of pancreas divisum. Gastrointest Endosc 26:143-146, 1980 https://doi.org/10.1016/S0016-5107(80)73305-9
  12. Burtin P, Person B, Charneau J, Boyer J. Pancreas divisum and pancreatitis: a coinsidental association? Endoscopy 23:55-58, 1991 https://doi.org/10.1055/s-2007-1010612
  13. Tuggle DW, Smith EI. Pancreas divisum, pancreatic pseudocyst and choledochal cyst in an 8-year old child. J Ped Surg 24:52-53, 1989 https://doi.org/10.1016/S0022-3468(89)80301-X
  14. Levi MJ, Geenen JE. Idiopathic acute recurrent pancreatitis. Am J Gastroenterol 96:2540-2555, 2001 https://doi.org/10.1111/j.1572-0241.2001.04098.x
  15. Komi N, Udaka H, Ikeda N, Kashiwagi Y. Congenital dilatation of the biliary tract: new classification and study with particular reference to anomalous arrangement of the pancreaticobiliaryducts. Gastroenterol Jpn 12:293-304, 1977 https://doi.org/10.1007/BF02776798
  16. Komi N, Takehara H, Kunitomo K, Miyoshi Y, Yagi T. Dose the type of anomalous arrangement of pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst? J Pediatr Surg 27: 728-731, 1992 https://doi.org/10.1016/S0022-3468(05)80102-2
  17. Ng JW, Wong MK, Huang J, Chan YT. Incomplete pancreas divisum coexistent with anomalous union of pancraticobiliary duct system. Gastrointest Endosc 38:105-106, 1992 https://doi.org/10.1016/S0016-5107(92)70364-2
  18. Kim KH, Lee SG, Lee YJ, Park KM, Hwang S, Choi DL, Nam CH, Min PC, Lee SK. Clinical analysis of anomalous pancreaticobiliary ductal union. J Korean Surg Soc 57:428-435, 1999
  19. Kim KH, Lee SS, Kim CD, Lee SK, Kim HJ, Park HJ, Joo YH, Kim DI, Yoo KS, Seo DW, Min YI. Incomplete pancreas divisum: is it merely a normal anatomic variant without clinical implications? Endoscopy 33:778-785, 2001 https://doi.org/10.1055/s-2001-16521