遠藤 正章¹, 棟方 博文¹, 羽田 隆吉¹, 須貝 道博¹, 井上 茂章¹, 小野 慶一¹, 栗田 武彰², 加藤 智²

Masaaki ENDOH¹, Hirofumi MUNAKATA¹, Ryukichi HADA¹, Michihiro SUGAI¹, Shigeaki INOUE¹, Keiichi ONO¹, Takeaki KURITA², Satoru KATO²

¹弘前大学医学部第二外科, ²木造成人病センター外科

¹The Second Department of Surgery, Hirosaki University School of Medicine, ²Department of Surgery, Kizukuri Adult Disease Center Hospital

キーワード : Anomalous union of the pancreatico-biliary ductal system, Ultrasonography

We examined a case of anomalous union of the pancreatico-biliary duct system (AUPBDS) with fusiform dilatation of the common bile duct diagnosed using ultrasonography (US) before cholangiography.
The patient was a 9 year-old boy with recurring abdominal pain. An ultrasonogram obtained by first filling the stomach and duodenum with water revealed the junction of the pancreatico-biliary duct system to be located in the pancreatic parenchyma. This was pathognomonic for AUPBDS. We also found that the long narrow segment, composed of the constricted part of the common bile duct and the common channel, ran deep in the pancreatic parenchyma to the papilla of Vater. This was also characteristic of AUPBDS. A subsequent cholangiography via the PTCD tubing clearly showed AUPBDS, confirming the diagnosis established using US.
We believe that US can be an useful method for imaging the extramural junction of the pancreatic and biliary duct in AUPBDS patients.