Nadir Bir Konjenital Safra Anomalisi: Pankreatikobiliyer Bilişim Anomalisi

Year 2021, Volume: 3 Issue: 2, 154 - 156, 06.05.2021

Hilal Er Ulubaba , İdris Kırhan , Rukiye Çiftçi

https://doi.org/10.37990/medr.865798

Cited By: 1

Abstract

20 yaşında kadın hasta kuşak tarzında karın ağrısı, bulantı ve kusma şikayetleri ile başvurdu. Hastanın özgeçmişinde 2 yıl önce geçirilen pankreatit öyküsü tespit edildi. Fizik muayenesinde epigastrik bölgede hassasiyet saptanıp, diğer sistem muayeneleri normaldi. Laboratuvar incelemelerinde; Amilaz 1249 ıu/l, Lipaz 1068 u/l CRP 49.83mg/l olup yüksek tespit edildi. Karaciğer fonksiyon testleri, böbrek fonksiyon testleri ve elektrolitleri normaldi. Abdomen ultrasonografisinde pankreas boyutu artmış ve hafif ödemli rapor edildi. Bu bulgularla hasta yatırılıp intravenöz sıvı replasmanı başlandı. Vital bulguları stabil olan hastaya MRCP yapıldı. MRCP’sinde; ortak safra kanalı ile pankreatik kanalın normal anatomik lokalizasyondan 17 mm proksimal kesimde birleştiği tespit edildi. Pankreatikobiliyer bileşim (PBA) anomalisi nadir tespit edilen bir konjenital anomali olup, son yıllarda MRCP gibi ileri radyolojik tetkiklerin yaygın olarak kullanımı nedeniyle tanı sıklığı artmaktadır. Tekrarlayan pankreatit atakları olan hastada, manyetik rezonans kolanjiyopankreatografi (MRCP) ile saptadığımız pankreatikobiliyer birleşim anomalisi (PBA)’ ni sunmayı amaçladık.

Keywords

Pankreatikobiliyer bileşim, konjenital anomali, pankreatit, MRCP

A Rare Congenital Biliary Anomaly: Anomalous Pancreaticobiliary Junction

Abstract

20-year-old female patient was admitted with complaints of girdle-like abdominal pain, nausea and vomiting. A history of pancreatitis 2 years ago was found in the patient’s anamnesis. Physical examination showed tenderness in the epigastric region, other system examinations were normal. In laboratory tests, amylase was found as 1249 ıu/l, lipase was found as 1068 u/l, CRP (C-Reaktif Protein) was found as 49.83mg/l and they were found to be high. Liver function tests, kidney function tests and electrolytes were found to be normal. In the abdomen ultrasonography, pancreas was reported to have increased size and mild edema. The patient was hospitalized with these findings and intravenous fluid replacement was started. Magnetic resonance cholangiopancreatography (MRCP) was performed on the patient whose vital findings were stable. MRCP showed that common bile duct and pancreatic duct were joined at 17 mm proximal from the normal anatomic location. Anomalous pancreaticobiliary junction (APBJ) is a rare congenital anomaly and in recent years its diagnosis frequency has increased due to the widespread use of advanced radiological examinations such as MRCP. The purpose of this case presentation was to present the APBJ that we detected with MRCP in a patient with recurrent pancreatitis attacks.

Keywords

Pancreaticobiliary junction, congenital anomaly, pancreatitis, MRCP.

References

• Referans1 Kamisawa, T., Takuma, K., Itokawa, F., & Itoi, T. Endoscopic diagnosis of pancreaticobiliary maljunction. World journal of gastrointestinal endoscopy. 2011; 3(1), 1.
• Referans2 Hu, B., Gong, B., & Zhou, D. Y. Association of anomalous pancreaticobiliary ductal junction with gallbladder carcinoma in Chinese patients: an ERCP study. Gastrointestinal endoscopy. 2003; 57(4), 541-54- 5.
• Referans3 Kamisawa, T., Kaneko, K., Itoi, T., & Ando, H. Pancreaticobiliary maljunction and congenital biliary dilatation. The Lancet Gastroenterology & Hepatology. 2017; 2(8), 610-618.
• Referans4 Miyano T, Yamataka A. Choledochal cysts. Curr Opin Pediatr. 1997; 9: 283–88.
• Referans5 Kim HJ, Kim MH, Lee SK, et al. Normal structure, variations, and anomalies of the pancreaticobiliary ducts of Koreans: a nationwide cooperative prospective study. Gastrointestinal Endosc. 2002; 55: 889–96.
• Referans6 Aksu, A. Ü., Sarı, S., Gürkan, Ö. E., & Dalgıç, B. Türk çocuklarda pankreatit: Tek merkez deneyimi. Cukurova Medical Journal. 2019;44(3), 991-998.
• Referans7 Kamisawa, T., Ando, H., Suyama, M., Shimada, M., Morine, Y., Shimada, H., & Working Committee of Clinical Practice Guidelines for Pancreaticobiliary Maljunction. Japanese clinical practice guidelines for pancreaticobiliary maljunction. Journal of gastroenterology. 2012; 47(7), 731-759.
• Referans8 Fukuzawa, H., Kajihara, K., Tajikawa, T., Aoki, K., Ajiki, T., & Maeda, K. (2020). Mechanism of pancreatic juice reflux in pancreaticobiliary maljunction: A fluid dynamics model experiment. Journal of Hepato‐Biliary‐Pancreatic Sciences. 2020; 27(5), 265-272.
• Referans9 Anderson, S. W., Zajick, D., Lucey, B. C., & Soto, J. A. 64-detector row computed tomography: an improved tool for evaluating the biliary and pancreatic ducts?. Current problems in diagnostic radiology. 2007;36(6), 258-271.