Complex pancreaticobiliary maljunction diagnosed by endoscopic ultrasound: A case report

Rationale: This case report aims to enhance understanding of pancreatobiliary maljunction (PBM) and promote more proactive treatment. Patient concerns: The patient, a 24-year-old Chinese female, was admitted to the hospital on April 7, 2020, due to “recurrent abdominal pain for over 2 years, with a recent episode accompanied by nausea and vomiting for 1 day.” She had a previous history of gallstones. Diagnoses: The initial diagnosis upon admission was biliary acute pancreatitis. During the emergency endoscopic retrograde cholangiopancreatography (ERCP) procedure, anatomical abnormalities were discovered. Intraoperative endoscopic ultrasonography led to a diagnosis of complex PBM (JSPBM, type D) + choledochal cyst (Todani, Ic) + incomplete pancreatic divisum + early chronic pancreatitis. These diagnoses were confirmed by postoperative magnetic resonance cholangiopancreatography. Interventions: After multiple conservative treatments such as ERCP with accessory pancreatic duct stent placement, the patient underwent surgical treatment in April 2021, which included “laparoscopic left hemihepatectomy + choledochal cyst excision + cholecystectomy + hepatic portal cholangioplasty.” Outcomes: The patient has not experienced any abdominal pain since the surgery and is currently under regular follow-up. Lessons: Endoscopic ultrasound is effective for the diagnoses of complex PBM and incomplete pancreatic divisum. ERCP with pancreatic duct stent placement and surgical procedure is reliable for relieving the patient’s symptoms.