<Review> Variations of the Union between the Terminal Bile Duct and the Pancreatic Duct in Patients with Pancreaticobiliary Maljunction

Background and Purpose: Pancreaticobiliary maljunction (PBM) is an anomaly with an extramural location of the union between the bile duct and the pancreatic duct system in the duodenum, and is probably caused by disarrangement of the embryonic connection between the two duct systems that presents varied clini- cal manifestations. The aim of this study was to analyze and categorize various patterns of connection between the two duct systems in PBM patients in order to improve the precision of the diagnosis of PBM and to establish safe surgical procedures to treat it. Materials and Methods: We made group classifications of the patterns of connection between the two duct systems in 226 PBM patients based on radiologic or/and anatomical examinations.Results: The 226 cases of PBM were divided into three groups: Group A, 2 patients with a complicated con-nection pattern, Group B, 176 patients with a notch or a small duct segment distal to the terminal bile duct, Group C, 48 patients without a notch or the segment at the terminal bile duct. Conclusion: In Group A, the terminal bile duct was probably connected to one of the multi-branched main ducts of the ventral pancreas, while in Group B, it was probably connected to a second branch of the ventral pancreas, and in Group C, directly to the main pancreatic duct.