Bile Duct Changes in Chronic Pancreatitis

1. Pathogenesis:

• Alcoholism is the cause of chronic pancreatitis in a majority of cases.
   
• Other causes include hereditary pancreatitis, hyperlipidemia, hyperparathyroidism, cystic fibrosis, and trauma.
   
• Chronic inflammatory changes in the pancreas can lead to inflammatory strictures of the common bile duct.
   

2. Radiographic findings:

• Narrowing of distal common biliary duct appears smooth, gently tapered, and relatively long.
   
• This narrowing can be either CONCENTRIC or ECCENTRIC.
   
• Concentric narrowing may be caused by periductal fibrosis (from chronic pancreatitis) or edema (from acute pancreatitis).
   
• Eccentric narrowing may be caused by adjacent pseudocyst or abscess.
   
• Figure: operative cholangiogram shows long, smooth, tapered structure of distal common bile duct due to chronic pancreatitis. Note pancreatic calculi (arrows).
   





• Figures: Percutaneous Transhepatic Cholangiogram (PTHC) in 41 y.o. female with RUQ pain, jaundice, and emesis. Chronic pancreatitis with pseudocyst causing long, smooth, tapered narrowing. (A) AP view. (B) Lateral view shows common bile duct is bowed by pressure from adjacent pseudocyst.
   

             
A                                                              B