Summary
We report, in an adult, an asymptomatic association between cystic dilatation of the bile duct (type IV A in Todani's classification) and anomalous pancreatico-biliary ductal union (APBD) with stones in a long common channel. In APBD, the connection between the common bile duct and the main pancreatic duct is located outside the duodenal wall and is therefore not under the influence of the sphincter of Boyden. An abnormally long common channel is in excess of 15 mm. Two types of convergence anomalies are defined according to whether the bile duct opens into the main pancreatic duct (BP) or the main pancreatic duct into the bile duct (PB). In APBD, there is probably a reverse pressure gradient between the bile and pancreatic ducts, with regurgitation of pancreatic juice into the bile duct, repeated attacks of cholangitis, stenosis and cystic dilatation. A long common channel is associated with a higher incidence of carcinoma of the gall bladder or the bile duct.
Résumé
Nous rapportons, chez l'adulte, une association asymptomatique d'un kyste cholédocien (type IV A de la classification de Todani) et d'une anomalie de la convergence bilio-pancréatique (APBD), avec présence de calculs dans un canal commun long. En présence d'APBD, la réunion entre la voie biliaire principale et le conduit pancréatique se fait en dehors de la paroi duodénale et échappe au contrôle du sphincter hépato-pancréatique. Un canal commun long est considéré comme pathologique s'il est > 15 mm. S'il apparît que le canal pancréatique vient se jeter dans la voie biliaire, cette anomalie correspond au type P-B. S'il s'agit du canal cholédocien qui vient se jeter dans la voie pancréatique, l'anomalie est de type B-P. Dans ces anomalies de la convergence bilio-pancréatique, il est probable qu'il existe une inversion du gradient de pression bilio-pancréatique avec reflux de liquide pancréatique dans les voies biliaires engendrant cholangite, sténose et dilatation kystique. Un canal commun bilio-pancréatique long est associé, avec une grande fréquence, un cancer de la vésicule ou des voies biliaires.
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Richer, J.P., Faure, J.P., Morichau-Beauchant, M. et al. Anomalous pancreatico-biliary ductal union with cystic dilatation of the bile duct. Surg Radiol Anat 20, 139–142 (1998). https://doi.org/10.1007/BF01628919
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DOI: https://doi.org/10.1007/BF01628919