Effect of biliopancreatic tree anatomy on development of acute gallstone pancreatitis

Abstract

Background

Acute pancreatitis (AP) is a complex disorder with gallstones being the most common underlying cause. Anatomical variations of gallbladder, cystic duct (CD), common bile duct and main pancreatic duct and their courses and interactions with each other have been studied and shown to be related to development of AP in various studies. With this study, we aimed to investigate the relationship between biliopancreatic tree anatomy and acute gallstone pancreatitis.

Materials and methods

157 gallstone related AP patients and 75 control group patients were enrolled in the study. The level at which cystic duct opened to common bile duct (as in proximal-mid-distal 1/3) and type of cystic duct course and opening (parallel to CBD, perpendicular to CBD, straight anatomy, tortuous anatomy) were evaluated from MRCP scans. Additionally, diameters of main pancreatic duct, common bile duct and angles between main pancreatic duct-common bile duct and cystic duct-common bile duct were calculated.

Results

All investigated parameters except CD opening angle were statistically significantly different between two groups. MPD opening angle was more acute in the control group. Parallel and tortuous CD was more common in the patient group. Patients with acute gallstone pancreatitis were more likely to have CD opening to the second and third parts of CBD.

Conclusion

Anatomy of the biliopancreatic tree and its variations are related to acute gallstone pancreatitis. Several proposed mechanism are thought to play role in this phenomenon but future prospective studies are required to reveal more on the topic.