Elif PEKER, Nuray HALİLOĞLU, Esra KAVUKÇU, Ayşe ERDEN

4225

Pankreatikobilyer semptomları olan hastalarda insidental

Amaç: Pankreatikobilyer semptomları olan hastaların MRCP incelemelerinde insidental olarak saptanan 24 jukstapapiller divertikülün (JPD) MRCP bulgularının sunulması ve bunların pankreatik kanal, safra yolları ve pankreas üzerine olan etkilerinin belirlenmesi. Hastalar ve Yöntemler: 1-T MR ünitesinde elde edilen ve arşivlenmiş MRCP görüntüleri iki radyolog tarafından tekrar değerlendirilmiştir. Saptanan JPD’lerin yerleşimi ve boyutları, safra kesesinde veya koledokta taş varlığı, safra kanallarında veya pankreatik kanalda dilatasyon ve ana safra kanalında JPD’ye bağlı olarak oluşan deviasyon not edilmiştir. İntrahepatik safra yolları, koledok, pankreatik kanal, safra kesesi ve pankreas parankimi eşlik eden pankreatikobilyer hastalıklar yönünden değerlendirilmiştir. Bulgular: Saptanan tüm JPD’ler (n=24) duodenum 2. bölümünün medial kesiminde yerleşimliydi. JPD’lerin ortalama çapı 2.25 cm ölçülmüştür. Aksiyel T2-ağırlıklı FSE görüntülerde divertiküllerin %95.8’inde (n=23/24) hava-sıvı seviyesi tespit edilmiştir. Kolesistektomi hikayesi olan 6 hasta değerlendirmeden çıkartıldığında hastaların %44.4’ünde (n=8/18) safra kesesinde taş tespit edilmiştir. Hastaların %45.8’inde (n=11/24) koledokta dilatasyon, %58.3’ünde (n=14/24) intrahepatik safra yollarında dilatasyon, %45.8’inde de (n=11/24) pankreatik kanalda dilatasyon saptanmıştır. Hastaların %12.5’inde (n=3/24) koledokta deviasyon izlenmiştir. Üç olguda (%12.5, n=3/24) koledokolitiyazis saptanmıştır. Sonuç: JPD’lerin saptanmasında ve pankreatikobilyer sistem üzerine olan etkilerinin değerlendirilmesinde MRCP faydalı bir radyolojik yöntemdir. Çalışmamızdaki olgu sayımız fazla olmasa da JPD’nin pankreatikobilyer semptomlara yol açtığını öne sürmekteyiz.

MRCP findings of incidentally detected juxtapapillary diverticula in patients with pancreaticobiliary symptoms

Aim: To describe the MRCP imaging features of 24 juxtapapillary diverticula (JPD) which were incidentally found on the MRCP studies of the patients with pancreaticobiliary symptoms, and to determine whether they effect pancreatic or biliary ducts, gall bladder, and pancreas. Materials and Methods: Archived MRCP images which were obtained by a 1-T MR unit, were reevaluated by two radiologists. The location and size of the JPD were noted. Intrahepatic biliary ducts, common bile duct (CBD), main pancreatic duct, gallbladder, and pancreatic parenchyma were evaluated to reveal any associated pancreatobiliary disease. Presence of gallbladder stones or choledocholithiasis, dilatation of bile ducts or pancreatic duct, deviation of the CBD caused by the JPD were noted. Results: All of the JPD (n: 24) were located medially at the second part of the duodenum. The mean diameter of JPD was 2,25 cm. Axial T2-weighted FSE images demonstrated air-fluid levels in 95.8% (n=23/24) of the diverticula. Excluding the six patients with previous cholecystectomy, gallbladder stones were detected in 44.4% (n=8/18) of the patients. CBD was dilated in 45.8% (n=11/24), intrahepatic biliary ducts were dilated in 58.3% (n=14/24), and pancreatic duct was dilated in 45.8% (n=11/24) of the patients. CBD deviation was observed in 12,5% (n=3/24) of the patients. Three patients (12,5%, n=3/24) had choledocholitiasis. Conclusion: MRCP is a useful radiological method in determining the JPD, as well as their effects on the pancreatobiliary system. Even though this is study with a small number of patients, we can still postulate that the JPD can cause changes leading to pancreaticobiliary symptoms.
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Ankara Üniversitesi Tıp Fakültesi Mecmuası-Cover
  • Başlangıç: 1947
  • Yayıncı: Erkan Mor
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