MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHIC EVALUATION OF HEPATOBILIARY AND PANCREATIC DUCTAL ANATOMY AND ITS VARIATIONS IN THE KASHMIRI POPULATION: A CROSS-SECTIONAL STUDY

Background: Anatomical variations of the hepatobiliary and pancreatic ductal systems are common and may haveimportant clinical implications during hepatobiliary and pancreatic surgery, endoscopic procedures, and radiologicalinterventions. Failure to acknowledge these differences can lead to an increased risk of injury to the duct and postoperativecomplications. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive imaging technique that can obtaindetailed information about biliary and pancreatic ductal anatomy. But there is not much information available about theoccurrence and mode of occurrence of such variations in the Kashmiri population. In our study we aimed to assess thenormal anatomy and to find the incidence and nature of hepatobiliary and pancreatic ductal system anatomical variations inthe Kashmiri population by MRCP. Materials and Methods: This is an observational cross-sectional study of 314 peoplewho had MRCP. The number of study population was 110 males and 204 females. MRCP images were assessed forintrahepatic biliary ductal branching, cystic duct anatomy, course of the main pancreatic duct, developmental anomalies ofthe pancreatic ductal system and pancreatic duct configuration. Data were presented as frequencies and percentages.Results: The 73.5% of the participants were found to have normal biliary anatomy. The most frequent intrahepatic biliaryvariation was Type 2, followed by Type 3a, Type 5a, Type 3c and Type 5b. In 3.18% of the cases rare biliary variants suchas ectopic drainage of the right posterior sectoral duct were detected and aberrant drainage from the right hepatic lobe wasdetected in 0.19% of the cases. Type 1 pancreatic duct configuration was the most prevalent (270, 86.0%), Type 3 was seenin 30 (9.5%), Type 4 in 11 (3.5%) and Type 5 in three (0.9%). Type 2 configuration was not seen. Descending course of themain pancreatic duct was found in 289 participants (92.07%), sigmoid course was found in 17 (5.4%), vertical course wasfound in 6 (1.9%) and loop-shaped course was found in 2 (0.63%). Eleven participants (3.5%) had complete pancreaticdivisum and three participants (0.95%) had annular pancreas. There was no incomplete pancreatic divisum, pancreatic ductduplication or abnormal pancreaticobiliary ductal union. Conclusion: Variations of hepatobiliary or pancreatic duct wereseen in a high proportion of the study population. While some of these variations may be asymptomatic, their recognition iscrucial in the interpretation of the radiological images and to minimize complications during surgical, endoscopic andinterventional procedures. MRCP is a safe non-invasive technique for outlining the anatomy of the ducts and detectingclinically significant anatomical variations.