|
1
|
Ott L, O’Neill J, Cameron D, Callahan MJ, Grover A, Fox VL, Kim HB, Lillehei C, Cuenca AG. Triple gallbladder with heterotopic gastric mucosa: a case report. BMC Pediatr 2022; 22:52. [PMID: 35057772 PMCID: PMC8772126 DOI: 10.1186/s12887-022-03122-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Triple gallbladder is a rare congenital anomaly of the biliary tract that can be associated with heterotopic tissue. Gallbladder triplication results from the failure of rudimentary bile ducts to regress during embryological development, and can be difficult to distinguish from Todani type II choledochal cysts and biliary duplication cysts. Case presentation A 2-year-old patient presented to our institution with intermittent abdominal pain for 1 year. She had elevated transaminases with imaging concerning for a choledochal cyst. After assessment with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography, she was diagnosed with a gallbladder multiplication and a common bile duct stricture. She underwent laparoscopic cholecystectomy, which confirmed the diagnosis of triple gallbladder. One of the three gallbladders demonstrated heterotopic gastric mucosa on final pathology, including at the cystic duct margin. Follow up testing with a technetium 99 m scan demonstrated a subtle focus of increased activity in the right upper abdomen at the expected location of the common bile duct, concerning for the presence of residual gastric mucosa. The patient remains well without abdominal pain. Conclusions We describe the first case of heterotopic gastric mucosa in a triple gallbladder in a young patient presenting with chronic abdominal pain. We also demonstrate the safety and feasibility of laparoscopic cholecystectomy in young children with triple gallbladder. Finally, we propose an interdisciplinary approach to the management of common bile duct strictures in the setting of ectopic acid secretion, involving a combination of medical management, endoscopic intervention, and possible salvage laparoscopic Roux-en-Y hepaticojejunostomy.
Collapse
|
|
2
|
Park YM, Seo HI, Kim S, Hong SB, Lee NK, Kim DU, Han SY, Lee SJ, Kim JR. Relationship between high bile juice amylase levels and chronic bacterial infections in patients with gallbladder cancer. Ann Surg Treat Res 2022; 102:125-130. [PMID: 35317353 PMCID: PMC8914527 DOI: 10.4174/astr.2022.102.3.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Pancreatic enzyme reflux into the biliary tract is associated with chronic inflammation and increased cellular proliferation in the biliary epithelium, leading to biliary carcinoma. We evaluated the relationship between high bile juice amylase levels and biliary microflora in patients with malignant gallbladder lesions. Methods In this retrospective study, 25 gallbladder specimens were obtained from patients with gallbladder cancer to evaluate amylase levels and perform bacterial culture. The samples were divided into high and low amylase groups and culture-positive and negative groups for analysis. Bile juice amylase 3 times higher than the normal serum amylase level (36–128 IU/L) was considered high. Results The number of positive cultures was higher in the high amylase group than in the low amylase group, but the difference was insignificant. There were no differences in other clinicopathological factors. Sixteen patients showed positive culture results; Escherichia coli and Klebsiella spp. were the most common gram-negative bacteria, whereas Enterococcus and Streptococcus spp. were the most common gram-positive bacteria. Age and bile juice amylase levels were significantly higher in the culture-positive group than in the culture-negative group. The incidence of bacterial resistance to cephalosporins was 6.25%–35.29%, and this incidence was particularly high for lower-generation cephalosporins. Conclusion Bacteria in gallbladder were identified more frequently when the amylase level was high. High amylase levels in the gallbladder can be associated with caused chronic bacterial infections with occult pancreaticobiliary reflux, potentially triggering gallbladder cancer.
Collapse
Affiliation(s)
- Young Mok Park
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyung Il Seo
- Department of Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Suk Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Radiology, Pusan National University School of Medicine, Busan, Korea
| | - Seung Baek Hong
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Radiology, Pusan National University School of Medicine, Busan, Korea
| | - Nam Kyung Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Radiology, Pusan National University School of Medicine, Busan, Korea
| | - Dong Uk Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sung Yong Han
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - So Jeong Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Jae Ri Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| |
Collapse
|
|
3
|
Azahouani A, Zaari N, Aissaoui FE, Hida M, Fitri M, Benradi L, Benhaddou H. [Cyst of the broken common bile duct: literature review]. Pan Afr Med J 2019; 33:276. [PMID: 31692842 PMCID: PMC6815484 DOI: 10.11604/pamj.2019.33.276.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/27/2018] [Indexed: 12/04/2022] Open
Abstract
Les malformations kystiques des voies biliaires sont des affections congénitales rares évaluées à environ 1/2 000 000 naissances. C'est une affection qui peut se révéler gravement par une complication notamment l'angiocholite, la pancréatite chronique, cirrhose biliaire progressive, l'hypertension portale ou les lithiases biliaires. Sa perforation spontanée est l'une des rares complications, décrite pour la première fois en 1934 par Weber. Nous rapportant le cas d'un garçon de 18 mois admis pour syndrome sub-occlusif avec une péritonite biliaire. Une échographie a été réalisée montrant un épanchement abdominal avec formation kystique communicante des voies biliaires associée à un épanchement sous capsulaire du foie confirmé par scanner. L'intervention a consisté en une toilette péritonéale avec mise en place d'un drain de redon au niveau de la perforation et un drain sous hépatique sans excision du kyste. Le patient a été réadmis 6 mois après cet incident pour sa cure définitive.
Collapse
Affiliation(s)
- Ahmed Azahouani
- Service de Chirurgie Pédiatrique, CHU Mohamed VI, Oujda, Maroc
| | - Najlae Zaari
- Service de Chirurgie Pédiatrique, CHU Mohamed VI, Oujda, Maroc
| | | | - Mohamed Hida
- Service de Chirurgie Pédiatrique, CHU Mohamed VI, Oujda, Maroc
| | - Mohamed Fitri
- Service de Chirurgie Pédiatrique, CHU Mohamed VI, Oujda, Maroc
| | - Larbi Benradi
- Service de Chirurgie Pédiatrique, CHU Mohamed VI, Oujda, Maroc
| | | |
Collapse
|
|
4
|
Almehdar A, Chavhan GB. MR cholangiopancreatography at 3.0 T in children: diagnostic quality and ability in assessment of common paediatric pancreatobiliary pathology. Br J Radiol 2013; 86:20130036. [PMID: 23457194 DOI: 10.1259/bjr.20130036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the diagnostic quality of MR cholangiopancreatography (MRCP) at 3.0 T in children and to assess its diagnostic ability in answering the clinical query. Also, to determine the frequency of artefacts and anatomic variations in ductal anatomy. METHODS Consecutive MRCPs performed in children using a 3-T scanner were retrospectively reviewed to note indications, findings, imaging diagnosis, normal variants, quality and artefacts. Analysis was performed based on the final diagnosis assigned by pathology or the combination of clinical, laboratory, imaging features and follow-up to determine whether it was possible to answer the clinical query by MRCP findings. RESULTS There were 82 MRCPs performed at 3.0 T on 77 children. 42/82 (51%) MRCPs were of good quality, 35/82 (43%) MRCPs were suboptimal but diagnostic and the remaining 5/82 (6%) MRCPs were non-diagnostic. MRCP answered the clinical query in 61/82 (74%) cases; however, it did not answer the clinical query in 11/82 (14%) cases and was equivocal in 10/82 (12%) cases. There was significant association between the quality of MRCP and the ability of MRCP to answer the clinical query (p<0.0001). 64/82 (78%) MRCP examinations had at least 1 artefact. Variation in the bile duct anatomy was seen in 27/77 (35%) children. CONCLUSION MRCP performed at 3.0 T is of diagnostic quality in most cases and is able to provide an answer to the clinical query in the majority of cases. ADVANCES IN KNOWLEDGE 3-T MRCP is feasible and useful in the assessment of pancreatobiliary abnormalities in children.
Collapse
Affiliation(s)
- A Almehdar
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
|
5
|
Yun SP, Lee JY, Jo HJ, Kim HS, Kim DH, Kim JH, Park SJ, Park DY, Seo HI. Long-term follow-up may be needed for pancreaticobiliary reflux in healthy adults. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:101-6. [PMID: 23397015 PMCID: PMC3566467 DOI: 10.4174/jkss.2013.84.2.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/13/2012] [Accepted: 12/14/2012] [Indexed: 01/03/2023]
Abstract
PURPOSE The reflux of pancreatic enzymes into the biliary tract is associated with chronic inflammation and increases cellular proliferation of the biliary epithelium, leading to biliary carcinoma. The aim of this study is to detect the incidence of occult pancreaticobiliary reflux (OPBR) in patients who underwent elective cholecystectomy. METHODS Forty-seven patients with symptomatic gallstones who underwent cholecystectomy were recruited for this study. The gallbladder bile samples were obtained from the specimen of gallbladder and the amylase level was measured. The immunohistochemistry of p53, SMAD4 and Ki-67 were performed for the detection of metaplasia and dysplasia. RESULTS Biliary amylase was higher than the serum amylase in 10 patients (group A, 15,402.66 ± 33,592.43 IU/L; group B, 13.06 ± 18.12 IU/L). The mean age was 67.2 years in group A and 51.2 in group B (P < 0.01). The ratio of male to female was 1:2.3 and 1:1.8 in group A and B, respectively (P = 0.297). Eight patients in group A and thirteen patients in group B had inflammation (P = 0.014). The positive results of the Ki-67 test were exhibited in five cases in each group (P = 0.024). CONCLUSION Results from the study indicate that the age was older, degree of inflammation and positive rate of Ki-67 were higher when OPBR was suspected. In conclusion, the patients with OPBR would need long-term follow-up, because the OPBR can cause dysplasia and the reflux of pancreatic juice may be considered as a risk factor for extrahepatic bile duct carcinoma.
Collapse
Affiliation(s)
- Sung-Pil Yun
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
|
6
|
Jung SM, Seo JM, Lee SK. The relationship between biliary amylase and the clinical features of choledochal cysts in pediatric patients. World J Surg 2012; 36:2098-101. [PMID: 22552497 DOI: 10.1007/s00268-012-1619-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although the clinical features of choledochal cysts (CC) in different age groups have been widely studied, the causes of differences in clinical features are unknown. To determine the relationship between biliary amylase and the clinical features of CC in pediatric patients, clinical outcomes were compared in two groups with different amylase levels. METHODS From May 1995 to August 2010, 80 patients under 18 years old who underwent choledochal cyst excision and hepaticojejunostomy and measurements of biliary amylase levels were allocated to a low-amylase-level group (amylase level < 200 U/L, n = 26) and a high-amylase-level group (amylase level > 200 U/L, n = 54). Their medical records were retrospectively reviewed. RESULTS The median age was 4 months (range = 17 days-169 months) in the low group and 48 months (range = 22 days-147 months) in the high group (p = 0.008). In the low group, jaundice was the most common symptom, while abdominal pain was the main symptom in the high group. In histological findings, bile duct proliferation and cholestasis predominated in the low group and portal inflammation predominated in the high group. Radiological findings and preoperative laboratory data were also significantly different between the groups. Postoperative complications occurred in the high group only. There was no mortality in either group. CONCLUSION This study shows a relationship between biliary amylase level and clinical manifestations in pediatric patients with CC, implying that there are different underlying pathophysiologies with anomalous pancreaticobiliary ductal union (APBDU).
Collapse
Affiliation(s)
- Soo-Min Jung
- Department of Surgery, Samsung Medical Center, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
| | | | | |
Collapse
|
|
7
|
Diagnosis and management of choledochal cysts. Indian J Surg 2012; 74:401-6. [PMID: 24082594 DOI: 10.1007/s12262-012-0426-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 03/02/2012] [Indexed: 02/07/2023] Open
Abstract
Choledochal cysts are rare disease and of unknown etiology. These are typically a surgical problem of infancy and childhood, but in nearly 20 % of the patients the diagnosis is delayed until adulthood. The presentation and therapeutic strategies for choledochal cysts in adult may differ from that of childhood. The surgical management of choledochal cysts in adults is complicated by associated hepatobiliary pathology. Despite the absence of clinical trials, a consensus for the management of choledochal cysts is excision. This review examines the spectrum of hepatobiliary pathology encountered with choledochal cysts and the surgical alternatives for managing choledochal cysts based on review of relevant literature in English language indexed on MEDLINE.
Collapse
|
|
8
|
Diagnosis and management of choledochal cysts. Indian J Surg 2011; 74:29-34. [PMID: 23372304 DOI: 10.1007/s12262-011-0388-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 11/30/2011] [Indexed: 02/07/2023] Open
Abstract
Choledochal cysts are rare disease and of unknown etiology. They are typically a surgical problem of infancy and childhood, but in nearly 20% of the patients the diagnosis is delayed until adulthood. The presentation and therapeutic strategies for choledochal cysts in adult may differ from that of childhood. The surgical management of choledochal cysts in adults is complicated by associated hepatobiliary pathology. Despite the absence of clinical trials, a consensus for the management of choledochal cysts is excision. This review examines the spectrum of hepatobiliary pathology encountered with choledochal cysts and the surgical alternatives for managing choledochal cysts based on review of relevant literature in the English language indexed on MEDLINE.
Collapse
|
|
9
|
Ellerkamp V, Kirschner HJ, Warmann SW, Schäfer J, Fuchs J. Bilateral single-system ectopic ureter associated with choledochal cyst: report of 2 cases. J Pediatr Surg 2010; 45:2450-3. [PMID: 21129566 DOI: 10.1016/j.jpedsurg.2010.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 08/10/2010] [Accepted: 08/11/2010] [Indexed: 11/27/2022]
Abstract
Ectopic ureters in children are associated with symptoms related to an abnormal localization or structure of the ureteric orifice including reflux or obstruction. Approximately 20% to 25% of ectopic ureters drain a nonduplicated renal system. Associated malformations are common in these cases. We treated 2 girls with bilateral single-system ectopic ureter associated with choledochal cysts. In both cases, ureteral reimplantation and resection of the choledochal cyst with hepaticojejunostomy were carried out. The coincidence of bilateral single-system ectopic ureter with choledochal cyst without any other severe malformation is not described in the literature.
Collapse
Affiliation(s)
- Verena Ellerkamp
- Department of Pedatric Surgery, Children's University Hospital Tuebingen, D-72076 Tuebingen, Germany.
| | | | | | | | | |
Collapse
|
|
10
|
Abstract
Choledochal cyst disease is uncommon. The presentation of the disease is being seen more commonly in the adult population than in the pediatric population, particularly in the West, making this a diagnosis a general surgeon should consider when evaluating a patient with biliary disease. The diagnosis of this disease has been greatly facilitated by improving technologies, particularly MRCP and interventional techniques of PTC. The consequences of not treating choledochal cysts can result in malignant transformation. When possible, complete surgical excision of the cyst is recommended and should be performed as early as possible to prevent complications and the progression of liver fibrosis. Long-term follow-up is required for surveillance for late complications and for cancer, particularly in type IV and V choledochal cysts where complete excision is not possible.
Collapse
Affiliation(s)
- Barish H Edil
- Department of Surgery, The Johns Hopkins University, 1550 Orleans Street, Cancer Research Building II, Room 506, Baltimore, MD 21231, USA.
| | | | | |
Collapse
|
|
11
|
Katsuno S, Ando H, Watanabe Y, Harada T, Seo T, Kaneko K. Hypogenesis of intramural vascularity and perivascular plexuses of gallbladder in patients with congenital biliary dilatation. ACTA ACUST UNITED AC 2009; 16:339-45. [PMID: 19283335 DOI: 10.1007/s00534-009-0066-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 06/22/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND We hypothesized neuronal disorders of the biliary tract as the cause of congenital biliary dilation (CBD). METHODS Gallbladders were removed from a total of 15 patients who were categorized into two study groups: a CBD group (eight patients) and in a control group (neuroblastoma, acute myelogenous leukemia, wandering gallbladder, Wilms' tumor, glycogen storage disease, familial amyloid polyneuropathy; seven patients). Whole-mount preparations of the gallbladders were made to immunostain the intramural nerves. RESULTS The intramural vascularity in the gallbladders of the CBD group (5.5 +/- 1.9/cm(2)) was significantly lower than that in the control group (27.6 +/- 14.4/cm(2)). The rate of perivascular plexuses on the surface of intramural vessels was also significantly lower in the CBD group than in the controls (37.7 +/- 18.1 vs. 80.2 +/- 17.4%, respectively). The numbers of ganglion cells per visual field were 38.5 +/- 24.0 and 42.3 +/- 20.6, respectively, in the CBD and control groups; this difference was not statistically significant. CONCLUSIONS There may be a mechanism in CBD causing contractile failure and dilatation of the biliary tract as a result of decreased intramural blood flow that accompanies the diminished vascularity.
Collapse
Affiliation(s)
- Shinsuke Katsuno
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8560, Japan.
| | | | | | | | | | | |
Collapse
|
|
12
|
Pancreaticobiliary malunion and incomplete pancreas divisum: an unusual cause of common bile duct obstruction. Adv Med Sci 2008; 53:6-10. [PMID: 18467273 DOI: 10.2478/v10039-008-0002-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Pancreaticobiliary malunion (PBM) is a distinct disease entity of the pancreatic and biliary ductal system defined as a condition in which the junction of the pancreatic and biliary ducts occurs above the duodenal wall. PBM may be combined with a stenosis of the distal common bile duct and pathological changes in the common bile duct wall (congenital cyst of bile duct), being a potentially malignant condition. Pancreas divisum, resulting from a fusion failure of the ventral and dorsal pancreatic buds, and characterized by a dominant Santorine duct, is considered to be a predisposing factor to recurrent attacks of acute pancreatitis. In incomplete pancreas divisum, the ventral and dorsal pancreas are connected by a segmental branch. MATERIAL AND METHODS We report a case of a 33-year-old female patient with PBM associated with incomplete pancreas divisum, who had presented episodes of acute cholangitis due to a benign distal common bile duct stricture. RESULTS Treatment with choledochoduodenostomy and cholecystectomy provided thorough relief and resolution of symptoms. CONCLUSION This is the first report of coexistent PBM and incomplete pancreas divisum in a Caucasian patient with unusually late clinical manifestation.
Collapse
|
|
13
|
Beltrán MA, Vracko J, Cumsille MA, Cruces KS, Almonacid J, Danilova T. Occult pancreaticobiliary reflux in gallbladder cancer and benign gallbladder diseases. J Surg Oncol 2007; 96:26-31. [PMID: 17345616 DOI: 10.1002/jso.20756] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES It was proposed that occult pancreaticobiliary reflux (OPBR) was associated with precancerous mucosal changes in the gallbladder, hence the importance of this disorder. There are no published reports investigating the incidence of OPBR in patients operated on for the entire spectrum of benign gallbladder diseases and gallbladder cancer. Our aim was to determine the incidence of OPBR and measure the levels of active pancreatic enzymes (amylase and lipase) in gallbladder bile of patients undergoing cholecystectomy for benign and malignant gallbladder diseases. METHODS One hundred eight patients with normal pancreaticobiliary junction evidenced by operative cholangiography were included in the study. RESULTS According to gallbladder bile amylase and lipase levels, 84.2% and 89% patients respectively had OPBR. OPBR was present in all gallbladder cancer patients; in these patients the biliary levels of amylase and lipase were significantly higher than the levels found in patients with benign gallbladder pathology (P < 0.0001). CONCLUSIONS OPBR could lead to inflammatory changes of the biliary epithelium and progress towards the development of precancerous mucosal changes and gallbladder cancer. The reason why such high levels of pancreatic enzymes are regurgitated into the biliary tree of patients with gallbladder cancer should be clarified.
Collapse
|
|
14
|
Jeong IH, Jung YS, Kim H, Kim BW, Kim JW, Hong J, Wang HJ, Kim MW, Yoo BM, Kim JH, Han JH, Kim WH. Amylase level in extrahepatic bile duct in adult patients with choledochal cyst plus anomalous pancreatico-biliary ductal union. World J Gastroenterol 2005; 11:1965-70. [PMID: 15800987 PMCID: PMC4305718 DOI: 10.3748/wjg.v11.i13.1965] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relationship between pancreatic amylase in bile duct and the clinico-pathological features in adult patients with choledochal cyst and anomalous pancreatico-biliary ductal union (APBDU).
METHODS: From 39 patients who underwent surgery for choledochal cyst between March 1995 and March 2003, we selected 15 adult patients who had some symptoms and were radiologically diagnosed as APBDU, and their clinico-pathological features were subsequently evaluated retrospectively. However, we could not obtain biliary amylase in all the patients because of the surgeon’s slip. Therefore, we measured the amylase level in gall bladder of 10 patients and in common bile duct of 11 patients.
RESULTS: Levels of amylase in common bile duct and gall bladder ranged from 11500 to 212000 IU/L, and the younger the patients, the higher the biliary amylase level (r = -0.982, P<0.01). Pathologically, significant correlation was found between the size of choledochal cyst and the grade of inflammation (r = 0.798, P<0.01). And, significant correlation was found between the level of amylase in gall bladder and the grade of hyperplasia. On the other hand, there was no correlation to the age of symptomatic onset or inflammatory grade (r = 0.743, P<0.05). Level of lipase was elevated from 6000 to 159000 IU/L in bile duct and from 14400 to 117000 IU/L in the gall bladder; however, there was no significant correlation with age or clinico-pathological features.
CONCLUSION: The results support the notion that amylase has a particular role in the onset of symptoms, and suggest that a large amount of biliary amylase induces early onset of symptom, thereby making early diagnosis possible.
Collapse
Affiliation(s)
- In-Ho Jeong
- Department of Surgery, Ajou University School of Medicine, Wonchondong, Yeongtonggu, Suwon 442-749, Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
15
|
Abstract
PURPOSE The cause of choledochal (cystic or fusiform) malformation is not known. A favoured hypothesis suggests that abnormal reflux of activated pancreatic secretions via a common pancreatobiliary channel may initiate mucosal injury and mural weakness leading to bile duct dilatation, at normal intraduct pressures. However, bile duct pressures in both normal or disease states are not known in such children. METHODS Intraoperative choledochal pressure (CP) measurements were made before any other manipulation. Bile was cultured and its amylase content measured. Biochemical liver function (bilirubin, aspartate aminotransferase, gamma-glutamyl transpeptidase, and alkaline phosphatase) was measured. Data were quoted as median (interquartile range). Statistical tests were parametric, where appropriate, and P = .05 was regarded as significant. RESULTS Twenty-five children (age 2.5 [1.25-5.91] years) with choledochal (cystic [n = 13] and fusiform [n = 12]) malformation coming to surgery were studied. Median CP was 13 (8.5-17) mm Hg. Median bile amylase was 6722 (241-18,000) IU/L. Choledochal pressure inversely correlated with bile amylase (r = -0.60, P = .001), serum aspartate aminotransferase (r = 0.46, P = .01), and log gamma-glutamyl transpeptidase (r = 0.4, P = .04) but not with bilirubin (P = .11), alkaline phosphatase (P = .20), or age (P = .11). No difference in CP, bile amylase, or liver biochemistry could be identified between the 2 biliary phenotypes. All bile cultures were sterile. CONCLUSIONS Increased CP is inversely related to the level of bile amylase (and hence degree of the functional common channel). This suggests that obstructive stenosis at the level of the pancreatobiliary junction (but not the ampulla) may be a causal factor in a proportion of choledochal malformations.
Collapse
Affiliation(s)
- Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital, SE5 9RS London, UK.
| | | |
Collapse
|
|
16
|
|