遠藤 正章¹, 須貝 道博¹, 羽田 隆吉¹, 鈴木 英登士¹, 棟方 博文¹, 佐々木 睦男¹, 栗田 武彰², 井上 茂章³, 杉山 譲¹, 今 充¹, 小野 慶一¹

Masaaki ENDOH¹, Michihiro SUGAI¹, Ryukichi HADA¹, Hidetoshi SUZUKI¹, Hirofumi MUNAKATA¹, Mutsuo SASAKI¹, Takeaki KURITA², Shigeaki INOUE³, Yuzuru SUGIYAMA¹, Mitsuru KONN¹, Keichi ONO¹

¹弘前大学医学部第2外科, ²木造成人病センター外科, ³青森県立中央病院外科

¹The Second Department of Surgery, Hirosaki University School of Medicine, ²Department of Surgery, Kizukuri Adult Disease Center Hospital, ³Department of Surgery, Aomori Prefectual Center Hospital

キーワード : Anomalous union of the pancreatico-biliary ductal system, Ultrasonography, Endoscopic ultrasonography, Intraoperative ultrasonography, Congenital choledochal dilatation

Ultrasonographic findings in patients with anomalous union of the pancreatico-biliary ductal system (AUPBDS) were compared with those obtaind by cholangio-pancreaticography (CPG). A total of 12 cases (5 for biliary joining type, 5 for pancreatic joining type and 2 for other types) were included in this study.
The results were as follows: (1) The intrapancreatic part of the common bile duct (CBD), narrow distal segment (NDS) and pancreatic duct (PD) could be visualized in 11 of the 12 cases; (2) The extramural and intrapancreatic joining of the PD and CBD-pathognomonic for anomalous union of the two ductal system-were demonstrated in 6 of the 11 cases; (3) In each of the 6 cases, the length of the common channel (CC) measured by US was well in agreement with that determined on CPG; (4) The intrapancreatic part of the CBD and CC situated anatomically deep in the pancreatic parenchyma. That is, they penetrated the pancreas. This was thought to be a telling feature of AUPBDS. The long narrow segment (LNS) composed of the constricted part of the distal CBD and CC could be observed in all cases of the biliary joining type, in 1 case of the pancreatic joining type and in 1 case of the other types. This finding was thought to be characteristic of AUPBDS of the biliary joining variety; and (5) The above-stated findings were also obtained by either EUS or operative US (OUS). OUS clearly showed the junction of the pancreatico-biliary ductal system in all cases, including the pancreatic joining type.
In conclusion, US, including EUS and OUS, could become a new method for diagnosing AUPBDS based on the anatomical relationship between the pancreatico-biliary ductal system and the surrounding structures.