Nadir Bir Konjenital Safra Anomalisi: Pankreatikobiliyer Bilişim Anomalisi

Öz

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.

Anahtar Kelimeler

• 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.

Kaynakça

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