Morbidity and treatment in the anomalous arrangement of the pancreaticobiliary ductal system

A nationwide survey of cases of congenital dilatation of the biliary duct was conducted to obtain the data on cases of congenital dilation of the biliary duct in Japan between 1972 and 1982. A total of 645 cases were surveyed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPABIDS) was associated with congenital dilatation of the biliary duct in 90.2% of the cases examined extensively. These cases and 62 cases that were collected in our hospital during the period from 1963 to 1984 were chosen as the subject of this study. The results may be summarized as follows: Various factors which affect the sphincter of Oddi are needed for the clinical manifestations of AAPABIDS. The incidence of biliary carcinoma increases with age, in parallel with that of intestinal metaplasia in cases of congenital dilatation of the biliary duct. These findings suggest that intestinal metaplasia may be one of the important factors in the development of biliary carcinoma. From the view points of timing and indication of surgery, it is necessary to cut off reflux of pancreatic juice into the biliary duct and remove the portion in which bile is stagnant prior to the development of serious complications.