Congenital Pancreatic and Biliary Anomalies

Congenital abnormalities of the pancreaticobiliary tree may go undetected until adulthood. MR cholangiopancreatography should be considered as part of the evaluation of adult patients with persistent and unexplained signs and symptoms of cholangitis, pancreatitis, jaundice, recurrent abdominal pain, or nausea and vomiting. Congenital pancreaticobiliary abnormalities seen in adults include choledochal cyst, anomalous junction of the pancreatic and common bile ducts, aberrant biliary ducts, pancreas divisum, choledochoceles, and annular pancreas. MR cholangiopancreatography can also demonstrate associated abnormalities such as choledocholithiasis or tumor. Recognition of congenital anomalies may aid in surgical planning and prevent inadvertent ductal injury. Although congenital pancreaticobiliary abnormalities are relatively uncommon, the increased prevalence of cholangitis, gallstones, and cholangiocarcinoma seen with the various types of biliary cystic disease and junctional anomalies and the increased association of pancreatitis seen with pancreatic anomalies make recognition of variant anatomy clinically important.