Anomalous pancreaticobiliary ductal union in tropical calcific pancreatitis.
Background: Tropical calcific pancreatitis is unique to developing countries with of unknown origin.
Objective: We evaluated the pattern of pancreaticobiliary ductal union in patients with tropical calcific pancreatitis.
Methods: Twenty-one patients with tropical calcific pancreatitis were compared to 174 control subjects with no pancreaticobiliary disease and 35 patients with alcohol-induced chronic pancreatitis. Methods: Two experienced people, blinded to the results, evaluated the pattern of pancreaticobiliary ductal union. Pancreaticobiliary ductal unions were classified as: separate ducts (no union), a short common-channel (length less than 6 mm), a long common-channel (length ranging 6-15 mm) and anomalous pancreaticobiliary ductal union (length greater than 15 mm). Anomalous union was defined as P-B type when the pancreatic duct appeared to join the bile duct and B-P type when the bile duct appeared to join the pancreatic duct. Any disparities between the two investigators were sorted out by mutual discussion.
Results: Pancreaticobiliary ductal union in tropical calcific pancreatitis patients as compared to those in the control group was as follows: separate ducts, 23.8% vs. 49.4% (P=0.036); a short common-channel, 4.8% vs. 28.7% (P=0.017); a long common channel, 33.3% vs. 18.4% (P=0.144) and anomalous pancreaticobiliary ductal union, 38.1% vs. 3.4% (P<0.001). The B-P pattern of anomalous pancreaticobiliary ductal union was more frequent in tropical calcific pancreatitis than in the control group but there was no statistical significance (P=0.103). The angle of the pancreaticobiliary ductal union in the tropical calcific pancreatitis group was 88.1 + or - 36.2 degrees as compared to 20.0 + or - 11.5 degrees in control group (P<0.001). Alcohol-induced chronic pancreatitis (No. 35) predominantly had either separate ducts (65.7%) or a short common channel (25.7%).
Conclusions: We concluded that patients with tropical calcific pancreatitis in Kashmir had anomalous pancreaticobiliary ductal union, predominantly of B-P type with a wide angle of ductal union more frequently. This may be related to the etiology of tropical calcific pancreatitis in such regions.