A clinicopathologic study of choledochal cyst

Choledochal cyst is quite common in Japan. The etiology of this lesion is not clear, and there remain problems in its treatment as well. Radiologic investigation of the distal common bile and pancreatic ducts was performed by operative cholangiography and endoscopic retrograde cholangiopancreatograp...

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Bibliographic Details
Published in:World journal of surgery 1980-03, Vol.4 (2), p.231-236
Main Authors: Miyano, Takeshi, Suruga, Keijiro, Chen, Soul‐Chin
Format: Article
Language:English
Subjects:
Age Factors
Animals
Bile Duct
Biliary Atresia
Child
Child, Preschool
Common Bile Duct Diseases - congenital
Common Bile Duct Diseases - diagnostic imaging
Common Bile Duct Diseases - surgery
Cysts - congenital
Cysts - diagnostic imaging
Cysts - surgery
Disease Models, Animal
Dogs
Duodenum - surgery
Humans
Infant
Jejunum - surgery
Nous Avons
Pancreatic Duct
Pancreatic Juice
Postoperative Complications
Prognosis
Rabbits
Radiography
Rats
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Summary:Choledochal cyst is quite common in Japan. The etiology of this lesion is not clear, and there remain problems in its treatment as well. Radiologic investigation of the distal common bile and pancreatic ducts was performed by operative cholangiography and endoscopic retrograde cholangiopancreatography. Anomalies at the junction of these ducts were found in all of the patients. Localized cystic dilatation of the extrahepatic bile ducts without intrahepatic bile duct dilatation was produced experimentally by ligation of the distal choledochus in infant rats. Concerning the etiology, we agree with Babbitt's hypothesis that weakness of the choledochal wall is produced by reflux of pancreatic juice via an anomalous choledochopancreatic junction. We think that the stenosis associated with this anomaly is the critical factor. From our follow‐up study of 30 cases, we find excision of the cyst to be the most important part of treatment. Choledochal cysts presenting under 6 months of age had clinical symptoms and pathology similar to biliary atresia. Résumé Le kyste du cholédoque est fréquent au Japon. L'étiologie de cette lésion est mal connue et le traitement mal défini. Nous avons étudié, par cholangiographie peropératoire et cholangiowirsungographie rétrograde endoscopique, le segment distal du cholédoque et le canal pancréatique. Dans tous les cas, nous avons observé des anomalies de la jonction de ces canaux. Nous avons pu reproduire expérimentalement, par ligature du cholédoque distal chez des rats de 2 semaines, une dilatation kystique localisée des voies biliaires extrahépatiques, sans dilatation concommittante des canaux intrahépatiques. L'hypothèse étiologique proposée par Babbitt nous parait logique: la paroi cholédocienne est affaiblie par reflux de suc pancréatique à la jonction cholédoco‐pancréatique. Nous croyons que le facteur critique est la sténose associée à cette anomalie. Le follow‐up de nos 30 cas indique que l'excision du kyste est le geste thérapeutique le plus important. Dans les kystes du cholédoque chez les enfants de moins de 6 mois, les symptomes et les lésions sont comparables à ceux de l'atrésie biliaire.
ISSN:0364-2313
1432-2323
DOI:10.1007/BF02393586