Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept

Guelrud, Moisés; Morera, Claudio; Rodriguez, M.; Jaén, Domingo; Pierre, Reinaldo

doi:10.1016/s0016-5107(99)70224-5

Cited by 69 publications

(45 citation statements)

References 30 publications

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“…Some centres in South American and Asia have reported ERCP and sphincterotomy alone as definitive treatment for mild fusiform dilatation (or a least a common channel) although their long-term prognosis is not known, given that it does not abolish the pancreatic reflux. 21 Open surgery dates from 1895 when William Swain first described drainage of a choledochal cyst into an adjacent loop of jejunum. 22 Indeed, relatively simple internal drainage procedures (e.g.…”

Section: Managementmentioning

confidence: 99%

Congenital Choledochal Malformation: Not Just a Problem for Children

Dabbas

Davenport

2009

annals

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Choledochal cysts remain relatively uncommon in Western Europe and the US, although they are appreciably more common in Asia. Their aetiology remains obscure although abnormalities of the pancreaticobiliary junction may be the primary pathology in some, with biliary dilatation following reflux of activated pancreatic secretions. Most anomalies will present in childhood with obstructive jaundice or abdominal pain; a proportion may only present for the first time during adulthood, and some of these will show malignant transformation. The classical triad of pain, jaundice and a palpable mass is, however, not common. Complete cyst excision, where possible, and biliary reconstruction remain the aims for most types although there is still some controversy about the type of reconstruction. Laparoscopic reconstruction is possible but is still very much an advanced technique. The risk of long-term problems post-surgery is significant. Whether this is due to recurrent pancreatitis secondary to the retained common channel and/or a distal stump, or due to the development of biliary tract malignancy is still a cause for concern and indicates the need for adequate, prolonged follow-up.

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Section: Managementmentioning

confidence: 99%

Congenital Choledochal Malformation: Not Just a Problem for Children

Dabbas

Davenport

2009

annals

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“…The role of an obstructed CBD has been discussed as a pathogenetic factor. Abnormal function or dysmotility of the sphincter of Oddi has been noted in several patients with choledochal cysts 33,34 . Furthermore, oligoganglionosis of the distal CBD 35,36 may result in inadequate autonomic innervation, producing a functional obstruction and proximal dilatation analogous to achalasia or Chagas'disease of the oesophagus or to Hirschsprung's disease of the colon.…”

Section: Aetiologymentioning

confidence: 99%

Bile duct cysts in adults

Søreide

Kørner

Havnen

et al. 2004

British Journal of Surgery

179

191

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An increasing rate of occurrence of bile duct cyst is reported in adults. Type IV cysts are more frequent in adults than children. Presentation tends to be non-specific abdominal discomfort. Related hepatobiliary or pancreatic disease frequently precedes recognition, and may complicate the postoperative course. Surgical treatment aims to relieve complications deriving from the cysts and to reduce the significant risk of malignant change within the biliary tree. Complete cyst resection, cholecystectomy and Roux-en-Y hepaticojejunostomy reconstruction is standard. Controversy exists about the role of hepatic resection in type IV and V cysts, and the role of minimally invasive and laparoscopic treatment. In general, the outcome is good and a near-zero mortality rate has been reported in institutional series over the past decade.

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“…An anomalous pancreaticobiliary union has been observed in most children with choledochal cysts and recurrent pancreatitis (Figure 23.13) [31,57]. In this subgroup of patients, SOD has been demonstrated, suggesting that this motor abnormality might be related to the development of recurrent pancreatitis [58]. Moreover, because the sphincter of Oddi muscular segment is located within the duodenal wall, endoscopic sphincterotomy prior to surgery has been performed with excellent results, supporting this theory [58].…”

Section: Choledochal Cyst and Anomalous Pancreaticobiliary Unionmentioning

confidence: 76%