Action of pancreatic juice on the bile duct: Pathogenesis of congenital choledochal cyst

Kato, Taichi; Hebiguchi, Tatsuzo; Matsuda, Kiyoshi; Yoshino, Hiroaki

doi:10.1016/s0022-3468(81)80341-7

Cited by 43 publications

(23 citation statements)

References 5 publications

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“…18 The true pathophysiology of choledochal cyst is still unclear and is thought to be multifactorial. [18][19][20][21] Many doctors believe that choledochal cyst in older children results from an anomalous insertion of the distal CBD into the pancreatic duct of Wirsung that permits reflux of pancreatic juice into the biliary tree, resulting in cholangitis, which weakens the bile duct wall and leads to cyst formation. 8,21 It has also been suggested that, in infancy, choledochal cyst and BA are part of the spectrum of infantile obstructive cholangiopathy and may be found concurrently in this stage of life.…”

Section: Discussionmentioning

confidence: 99%

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

Lee

Yeung

Chang

et al. 2000

Journal of Ultrasound in Medicine

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We evaluated sonographically 162 children who met the criteria for biliary tract dilatation in the past 18 years. Of these, 131 patients were diagnosed as having anomalous dilatations of the biliary tree (including 112 with choledochal cysts and 19 with biliary duct dilatation and biliary atresia). Biliary tract dilatations in the other 31 patients were due to secondary causes or normal variants. All cases of intrahepatic biliary tree dilatation and those with both intra‐ and extrabiliary duct dilatations were anomalous. In 117 cases of extrahepatic biliary tract dilatation only, the mean diameter was widest in cases of choledochal cyst (21.4 +/‐ 12.1 mm, compared with cases of biliary tract dilatation with biliary atresia (10 +/‐ 2.4 mm), secondary biliary duct dilatation (8.5 +/‐ 1.5 mm), and normal variants (4.4 +/‐ 1.2 mm) (P < 0.001). Of the 43 infants with biliary tree dilatation, 24 (56%) had choledochal cysts and 19 (44%) had biliary tract dilatation associated with biliary atresia. Excluding cases associated with biliary atresia, the accuracy of diagnosing choledochal cysts in extrahepatic biliary tract dilatation was 71% and 97% using cutoffs of 7 mm and 10 mm as the minimum diameter, respectively.

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Section: Discussionmentioning

confidence: 99%

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

Lee

Yeung

Chang

et al. 2000

Journal of Ultrasound in Medicine

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“…[21][22][23][24][25] Numerous studies support the hypothesis first suggested by Babbit [25] that the reflux of pancreatic juice due to an anomalous pancreaticobiliary junction weakens the choledocal wall. For example, Kato et al [23] performed an animal study evaluating the effect of pancreatic juice on the bile duct wall after pancreaticocholecystostomy and observed that cylindrical dilation of the common bile duct, inflammatory change of submucosal layer, and damage of intercellular junction of biliary epithelium occurred in the early stage of the disease.…”

Section: Discussionmentioning

confidence: 86%

Common Bile Duct Stones Associated with Pancreatobiliary Reflux and Disproportionate Bile Duct Dilatation

Lee¹,

Park²,

Paik³

et al. 2009

Gastrointestinal Endoscopy

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“…16 Por outro lado, estudos em animal de experimentação demonstraram, através da anatomose do ducto pancreático com a vesícula biliar, que o refluxo de suco pancreático para a via biliar acarreta dilatações da mesma, em decorrência da ação lesiva dos fermentos pancreáticos sobre sua parede. 17,8 Em trabalho recente, ficou demonstrado que essa ação lesiva é o principal fator determinante da dilatação da via biliar, pois o estudo histopatológico da parede da via biliar demonstra fenômeno inflamatório, ulceração da mucosa e substituição da camada muscular por tecido fibroso, conforme os casos aqui apresentados. Além disso, estudos manométricos revelaram que não ocorre aumento de pressão no interior das vias biliares em crianças com ducto comum longo 16 , apesar das imagens radiográficas habitualmente sugerirem "estenose" da porção terminal do colédoco intra-pancreático.…”

Section: Discussionunclassified

“…Assim, a incidência de ducto comum longo em pacientes com cisto de colédoco varia de 40 a 100%. [4][5][6][7][8][9] Em publicação recente da escola japonesa, entre 26 pacientes com dilatação da via biliar, 25 apresentavam ducto comum longo (96,2%) 16 . Com base nesses conhecimentos, no caso 9 pôde-se dispensar a investigação radiológica aliado ao fato de que as condições clínicas da criança eram precárias.…”

Section: Discussionunclassified

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Biliary tract dilatation and abnormal choledocho-pancreatic ductal junction in children

Tannuri¹,

Pessoa²,

Sakane³

et al. 1994

J Pediatr (Rio J)

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Pediatria 359 ResumoSão apresentadas nove crianças cujas idades variaram entre 2 meses e 11 anos, com dilatação congênita da via biliar extra-hepática, com ou sem acometimento intrahepático, e oito delas, submetidas à investigação radioló-gica, apresentaram anomalia da junção entre o colédoco e o ducto pancreático principal. Forma-se assim um ducto comum longo, antes da penetração na parede duodenal, o que permite a passagem contínua de suco pancreático, rico em enzimas proteolíticas, para a árvore biliar. Como conseqüência, ocorre lesão da parede dos ductos biliares, substituição da camada muscular por tecido fibroso e dilatação em intensidade e extensão variáveis.O sintoma clínico mais importante foi a dor abdominal, acompanhada ou não de vômitos ou icterícia do tipo obstrutiva. Em apenas uma criança, havia dilatação do colédoco do tipo cística, que se manifestou clinicamente como massa palpável no hipocôndrio direito. Em oito crianças, o diagnóstico de dilatação da via biliar foi feito pela ultrassonografia abdominal e, em um caso, por visualização direta durante laparotomia de emergência. O diagnóstico de ducto comum longo foi confirmado pela colangiopancreatografia endoscópica transpapilar, no pré-operatório, ou pela colangiografia intra-operatória. Em apenas um caso, não foi feita investigação radiológica em virtude das más condições clínicas.O tratamento de eleição, realizado nos nove casos, foi a derivação bílio-digestiva em Y de Roux. O seguimento tardio revelou que todas as crianças estão bem, sem sintomas relacionados com a doença de base.J. pediatr. (Rio J.). 1994; 70(6):359-364: dilatação congê-nita do trato biliar, cisto de colédoco, canal comum colé-doco-pancreático. AbstractNine children aged between 2 months and 11 years, who had congenital dilatation of extrahepatic biliary tract, with or without intrahepatic dilatation, are presented. The radiological studies performed in eight patients demonstrated abnormal choledochopancreatico ductal junction. Thus, a long common channel is formed out of the duodenal wall, leading to a continuous reflux of pancreatic juice into the biliary system, chronic inflammation of biliary tract wall, fibrosis of muscular layer and finally different types of dilatations.The main clinical findings were upper abdominal pain, vomiting, or obstructive jaundice. In only one child the dilatation was cystic type and the clinical manifestation was palpable abdominal mass. In eight patients the initial diagnosis of biliary tract dilatation was made through abdominal ultrasound and in one case by direct visualization through emergent exploratory laparotomy. The final confirmation of the presence of long common channel was made by preoperative endoscopic retrograde cholangiopancreatography or intraoperative cholangiogram. The radiologic investigation was not performed in only one case due to bad clinical conditions. The surgical treatment indicated to all cases was Rouxen-Y hepatic-jejunostomy. The late follow up demonstrated that all patients are well and assymptomatic.J. pedia...

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Action of pancreatic juice on the bile duct: Pathogenesis of congenital choledochal cyst

Cited by 43 publications

References 5 publications

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

Common Bile Duct Stones Associated with Pancreatobiliary Reflux and Disproportionate Bile Duct Dilatation

Biliary tract dilatation and abnormal choledocho-pancreatic ductal junction in children

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