Background: Perforation of a
choledochal cyst (CC) is not rare, but the pathogenesis of
spontaneous perforation has not been established.
Pancreaticobiliary maljunction (
PBM) is commonly seen in association with
choledochal cyst. To explore the relationship between
PBM and perforated CC, a retrospective study was conducted. Methods: We analyzed all the patients with CC who underwent surgery in our hospital from 2014.06.01 to 2018.12.31. All patients were divided into two groups: group 1 were patients with perforated CC, and group 2 were patients with non-perforated CC. We recalled all the patients records to identify types of
PBM.
PBM was divided into four types [(A) stenotic type, (B) non-stenotic type, (C) dilated channel type, and (D) complex type] according to the classification proposed by the Committee on Diagnostic Criteria of the Japanese Study Group on
Pancreaticobiliary Maljunction (JSGPM) in 2015. Results: There were 186 patients with CC in all, and 116 patients showed
PBM. Twenty patients in group 1 and 96 patients in group 2. There was an extremely higher percentage of type C
PBM in group 1 than in group 2 (60 and 17.7%, respectively). More fusiform dilatation cases were found in group 1 (70%) than in group 2 (58.3%). Also there were more type C
PBM in fusiform cases and type A
PBM were frequently seen in cystic cases (P < 0.01). Conclusions: We found that Type C
PBM and fusiform common bile duct maybe relate to the perforation of
choledochal cyst. Patients with type C
PBM and fusiform common bile duct should be treated more proactively, preferably before they perforate.