A Clinical Study of Congenital Biliary Dilatation

Abstract

Thirteen patients with congenital biliary dilatation treated in our department were analyzed in relation to its complications and other features. Two of the 13 patients were associated with biliary tract cancer and Both lesions were unresectable, because of their advanced stages. The dilated bile ducts appeared cystic, and the cancers involved the intrahepatic bile ducts and dilated extrahepatic bile ducts. The level of amylase in bile was high, suggesting that prolonged regurgitation of pancreatic juice into the bile ducts had induced the canceration. Concomitant cholelithiasis was found in 5 patients, 3 of whom had bilirubin calciferous stones. Morpholog ically, the dilated bile duct was classified as type IV-A in 3 and type Ia and Ib in each one. Stones were intrahepatic in 2 of the 3 cases of type IV-A. Pancreatic lithiasis was found in 3 patients; stones were present in the Wirsung's canal, Santorini's canal and both canals in each one. Two of the 3 had no positive stones upon roentgenography. The pancreatic stones were removed by papilloplasty or accessory papilloplasty. The 3 patients were treated by resection of the dilated extrahepatic bile duct with bile duct reconstruction. Postoperative pancreatic fistula occurred in 2 patients undergone a second operation after cystoduodenostomy or cystojejunostomy, who could be successfully managed by conservative treatment alone. Prognosis was favorable in all patients except those accompanied by cancers.

Etiological relationships between choledochal cyst and anomalous junction of the pancreaticobiliary ductal system.

“…Babbitt's view that choledochal cyst is caused secondarily by the influx of pancreatic juice into the biliary tract14 appeared to be reasonable and may account for mild dilata tion such as the columnar type and spindle-shaped type, but it does no sufficiently explain the process of cystic dilatation. Miyano,69,71 Ando,76 and Nakashima et al 60,74 considered stenosis of the distal bile duct associated with anomalous pancreaticobiliary junction to be primarily responsible for bile duct dilatation and suggested that elevation in the intrabiliary ductal pressure due to stenosis while the wall of the biliary tract is still immature causes bile duct dilatation. This theory conveniently explains the develop ment of various morphological changes of the bile duct ranging from no dilatation to columnar or spindle-shaped dilatation and, eventually, cystic dilatation by combination of various degrees of stenosis and weakness of the bile duct wall.…”