Pathologico-Anatomic Categories of Choledochal End-Piece Stenosis Due to Chronic Pancreatitis and Clinical Significance

Abstract

Background: Chronic pancreatitis caused by common bile duct segment stenosis is a common complication. It often results in near side bile duct expansion, bile drain disorder, appearing serious obstructive jaundice, biliary cirrhosis, lifethreatening. However, chronic pancreatitis causes not bravery manager narrow some light, some heavy, and the clinical manifestation is different too. We think there may be different kinds of pathological anatomy. As a result, we carried out the research of this subject. Objective: To investigate the anatomicopathological classification of terminal stenosis of the common bile duct (CBD) caused by chronic pancreatitis (CP) and the treatment. Method: A retrospective analysis was made for the management of sympatomatic stenosis of the terminal end of CBD 47 CP cases. Autopsy was performed in 25 bodies to verify our classification. Result: By analyzing operation and postoperative follow-ups to 47 patients with obvious choledochal dilatations (diameter ≥ 15 mm) due to chronic pancreatitis, the authors have found that there exist three pathologico-anatomic categories of choledochal end-piece stenosis due to chronic pancreatitis. The stenosis of type I is the external-pressing annular stricture (59.6%); type II is front wall of choledochus being compressed one (31.9%); and type III is the pseudocystic oppression one (8.5%). Conclusion: The treatment of CP patients complicated with terminal stenosis of CBD need individual consideration. Clinical Significance: Type I should be treated with biliary-enterostomy owing to more serious stricture (only No.3 the Bake's dilstors and smaller ones can be passed through its stenotic segment). Type II Could be managed with T-tube drainage because of its slighter stricture (Bake's dilators bigger than No.6 and No.12 French urinary catheter can get through the Choledochal terminal). If there aren't biliary and pancreatic complicated diseases, non-operative treatment can be carried out. Type III can undergo with the T-tube replacement between biliary tract and pseudocyst if pseudocystic decompression doesn't lead to obvious stenosis (type IIIo and IIIb). If type III combines type I, the internal drainage should be performed in both ectatic bile duct and cyst.