A novel variant of pancreaticobiliary maljunction: Complete opening of the common bile duct into the duct of Santorini in a patient with pancreas divisum.
Kemal Dolay, Mehlika Bilgi Kirmaci
✦ AI-curated · Sources linked
Case in brief
A 20-year-old woman with recurrent cholestasis and acute pancreatitis presented with fever, jaundice, and abdominal pain; laboratory findings supported cholangitis and pancreatitis. Imaging and ERCP showed type D pancreaticobiliary maljunction, complete pancreas divisum, and drainage of the common bile duct into the duct of Santorini, with intraductal sludge. Endoscopic sphincterotomy and biliary stenting improved her initially, but symptoms persisted after extrahepatic bile duct resection and Roux-en-Y hepaticojejunostomy, leading to pylorus-preserving pancreaticoduodenectomy. Histology showed chronic inflammation without dysplasia or malignancy. She recovered and remains asymptomatic.
What made this case unusual
The common bile duct opened completely into the duct of Santorini in the setting of type D pancreaticobiliary maljunction and complete pancreas divisum.
Diagnostic / clinical pearl
In recurrent pancreatitis and cholangitis, define ductal anatomy carefully: cross-sectional imaging, MRCP, and ERCP identified the complex maljunction and aberrant bile duct drainage in this case.
Why it matters
Persistent pancreatitis despite endoscopic and biliary surgical management may require further individualized intervention in patients with complex ductal anomalies.