Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0040-1721341
Anomalía de la unión biliopancreática: una entidad infrecuente en Occidente
Pancreaticobiliary maljunction: a rare entity in the West![](https://www.thieme-connect.de/media/10.1055-s-00039252/202103/lookinside/thumbnails/10-1055-s-0040-1721341_2000005-1.jpg)
Resumen
La anomalía de la unión biliopancreática (AUBP) es una malformación congénita en la que los conductos pancreáticos y biliares se unen anatómicamente fuera de la pared duodenal. Debido a la excesiva longitud del canal común, la acción del esfínter no afecta la unión pancreatobiliar, lo que permite el reflujo del jugo pancreático hacia la vía biliar. Se asocia con quistes del colédoco y sus manifestaciones incluyen cáncer de la vía biliar, pancreatitis, coledocolitiasis y colangitis. Es una rara patología, especialmente en países occidentales.
La colangiopancreatografía por resonancia magnética (CPRM) se ha convertido en el método más utilizado por no ser invasivo, teniendo en cuenta que la colangiopancreatografía retrógrada endoscópica (CPRE) se encuentra contraindicada en casos de pancreatitis aguda y colangitis, además del riesgo de pancreatitis posterior al procedimiento.
La distancia entre la unión biliopancreática y la pared duodenal debe ser superior a 9 mm de longitud para diagnosticar AUBP mediante CPRM. En caso de que mida entre 6 y 9 mm y la acción del esfínter afecte la unión pancreatobiliar, se lo denomina unión biliopancreática alta (UBPA) y se debe confirmar mediante CPRE.
Describimos los hallazgos en imágenes de siete pacientes jóvenes con clínica abdominal y diagnóstico de AUBP o UBPA por CPRM, y además revisamos la literatura sobre el tema.
Abstract
Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and biliary ducts are anatomically joined outside the duodenal wall. Due to the excessive length of the common channel, the action of the sphincter does not affect the pancreaticobiliary junction, allowing the reflux of pancreatic juice into the bile duct. It is associated with cysts of the common bile duct and its manifestations include cancer of the bile duct, pancreatitis, choledocholithiasis and cholangitis. It is a rare pathology, especially in Western countries.
Magnetic resonance cholangiopancreatography (MRCP) has become the most used method because it is non-invasive, taking into account that endoscopic retrograde cholangiopancreatography (ERCP) is contraindicated in cases of acute pancreatitis and cholangitis, in addition to the risk of pancreatitis after the procedure.
The distance between the biliopancreatic junction and the duodenal wall must be greater than 9 mm in length to diagnose PBM by MRCP. If it is between 6 to 9 mm and the action of the sphincter affects the pancreaticobiliary junction, it is called high confluence of pancreaticobiliary ducts (HCPBD) and should be confirmed by ERCP.
We describe the imaging findings of 7 young patients with abdominal symptoms and diagnosis of PBM or HCPBD by MRCP, and also review the literature on the subject.
Palabras clave
Anomalía de la unión biliopancreática - colangiopancreatografía por resonancia magnética - vía biliar - páncreasKeywords
Pancreaticobiliary maljunction - Magnetic resonance cholangiopancreatography - Biliary tract - PancreasResponsabilidades éticas
Este es un trabajo observacional retrospectivo el cual cumplió los principios éticos de la Declaración de Helsinki en su última revisión de octubre del 2000.
Protección de personas y animales. Los autores declaran que para esta investigación no se han realizado experimentos en seres humanos ni en animales.
Confidencialidad de los datos. Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicación de datos de pacientes.
Derecho a la privacidad y consentimiento informado. Los autores declaran que en este artículo no aparecen datos de pacientes.
Publication History
Received: 20 January 2020
Accepted: 11 September 2020
Article published online:
04 February 2021
© 2021. Asociación Civil Sociedad Argentina de Radiología and Federacion Argentina de Asociaciones de Radiología, Diagnóstico por Imágenes y Terapia Radiante. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referencias
- 1 Itokawa F, Kamisawa T, Nakano T, Itoi T, Hamada Y, Ando H. et al. Committee of Diagnostic Criteria of The Japanese Study Group on Pancreaticobiliary Muljunction. Exploring the length of the common channel of pancreaticobiliary maljunction on magnetic resonance cholangiopancreatography. J Hepatobiliary Pancreat Sci. 2015; 22 (01) 68-73
- 2 Kamisawa T, Kurata M, Honda G, Tsuruta K, Okamoto A. Biliopancreatic reflux-pathophysiology and clinical implications. J Hepatobiliary Pancreat Surg. 2009; 16 (01) 19-24
- 3 Kamisawa T, Takuma K, Anjiki H, Egawa N, Kurata M, Honda G. et al. Pancreaticobiliary maljunction. Clin Gastroenterol Hepatol. 2009; 7 (11, Suppl): S84-S88
- 4 Hyvärinen I, Hukkinen M, Kivisaari R, Parviainen H, Nordin A, Pakarinen MP. Increased prevalence of pancreaticobiliary maljunction in biliary malignancies. Scand J Surg. 2019; 108 (04) 285-290
- 5 Le Roy B, Gagnière J, Filaire L, Fontarensky M, Hordonneau C, Buc E. Pancreaticobiliary maljunction and choledochal cysts: from embryogenesis to therapeutics aspects. Surg Radiol Anat. 2016; 38 (09) 1053-1060
- 6 Takuma K, Kamisawa T, Tabata T, Hara S, Kuruma S, Inaba Y. et al. Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation. World J Gastroenterol. 2012; 18 (26) 3409-3414
- 7 Kamisawa T, Ando H, Shimada M, Hamada Y, Itoi T, Takayashiki T. et al. Recent advances and problems in the management of pancreaticobiliary maljunction: feedback from the guidelines committee. J Hepatobiliary Pancreat Sci. 2014; 21 (02) 87-92
- 8 Guo WL, Huang SG, Wang J, Sheng M, Fang L. Imaging findings in 75 pediatric patients with pancreaticobiliary maljunction: a retrospective case study. Pediatr Surg Int. 2012; 28 (10) 983-988
- 9 Urushihara N, Hamada Y, Kamisawa T, Fujii H, Koshinaga T, Morotomi Y. et al. Classification of pancreaticobiliary maljunction and clinical features in children. J Hepatobiliary Pancreat Sci. 2017; 24 (08) 449-455
- 10 Tipnis NA, Dua KS, Werlin SL. A retrospective assessment of magnetic resonance cholangiopancreatography in children. J Pediatr Gastroenterol Nutr. 2008; 46 (01) 59-64
- 11 Huang SG, Guo WL, Wang J, Sheng M, Lan XH, Fang L. Factors Interfering with Delineation on MRCP of Pancreaticobiliary Maljunction in Paediatric Patients. PLoS One. 2016; 11 (04) e0154178
- 12 Funabiki T, Matsubara T, Miyakawa S, Ishihara S. Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy. Langenbecks Arch Surg. 2009; 394 (01) 159-169
- 13 Le Roy B, Gagnière J, Filaire L, Fontarensky M, Hordonneau C, Buc E. et al. Visualization of pancreaticobiliary reflux in anomalous pancreaticobiliary junction by secretin-stimulated dynamic magnetic resonance cholangiopancreatography. Acta Radiol. 2004; 45 (04) 375-382
- 14 Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg. 1977; 134 (02) 263-269