PubMed · 3916470
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P Upadhyaya. 1985. Choledochal cyst.. https://pubmed.ncbi.nlm.nih.gov/3916470/
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BACKGROUND: Sphincter of Oddi dysfunction is a benign, functional gastrointestinal disorder for which invasive endoscopic therapy with potential complications is often recommended. AIMS: To review the available evidence regarding the diagnostic accuracy of non-invasive methods that have been used to establish the diagnosis and to estimate the long-term outcome after endoscopic sphincterotomy. METHODS: A systematic review of English language articles and abstracts containing relevant terms was performed. RESULTS: Non-invasive diagnostic methods are limited by their low sensitivity and specificity, especially in patients with Type III sphincter of Oddi dysfunction. Secretin-stimulated magnetic resonance cholangiopancreatography appears to be useful in excluding other potential causes of symptoms, and morphine-provocated hepatobiliary scintigraphy also warrants further study. Approximately 85%, 69% and 37%, of patients with biliary Types I, II and III sphincter of Oddi dysfunction, respectively, experience sustained benefit after endoscopic sphincterotomy. In pancreatic sphincter of Oddi dysfunction, approximately 75% of patients report symptomatic improvement after pancreatic sphincterotomy, but the studies have been non-controlled and heterogeneous. CONCLUSIONS: Patients with suspected sphincter of Oddi dysfunction, particularly those with biliary Type III, should be carefully evaluated before considering sphincter of Oddi manometry and endoscopic sphincterotomy. Further controlled trials are needed to justify the invasive management of patients with biliary Type III and pancreatic sphincter of Oddi dysfunction.
BACKGROUND: Spontaneous perforation of the common bile duct is a rare but important cause of jaundice in infancy, requiring prompt diagnosis and surgical intervention. First described in 1932, fewer than 150 cases have been reported to date. CASE REPORT: The report concerns a 18-month-old girl who developed mild jaundice, abdominal distension, and constipation three days prior to admission. On admission, ascites and hepatomegaly were detected and the complete blood count was normal, but on the 3rd, 4th, and 5th days of admission, the blood cell count revealed elevation of the eosinophil count to 16% of total WBC. Abdominal sonography showed a moderate amount of ascitic fluid and paracentesis demonstrated biliary ascites. Hepatobiliary scintigraphy suggested leakage of bile to the abdominal cavity. Exploratory laparotomy revealed clear bilious ascitic fluid and a ruptured common bile duct at the anterior wall of the junction of the cystic duct and the common bile duct. Three days after T-tube insertion and closure of the perforation, the eosinophil count returned normal. CONCLUSIONS: Perforation of the bile duct may be considered as one of the differential diagnoses of eosinophilia. This point makes our case a unique study, worthy of being reported.
In the setting of chronic pancreatitis, pancreatic ductal obstruction, and ductal leak, pseudocyst formation and biliary obstruction present many challenges for endoscopists. Although chronic pancreatitis has a variety of clinical manifestations, most commonly patients present with intermittent or chronic abdominal pain. Recent studies suggest stenting of pancreatic ductal strictures has a significant impact on reducing chronic pain. The removal of ductal calculi, presumably from relieving obstruction, also improves abdominal pain. When the site of leak is bypassed, ductal leaks may be cured by endoscopic stenting. Multiple plastic bile duct stents to treat chronic pancreatitis-associated bile duct stricture can delay the need for surgery. Although these endoscopic techniques have been beneficial for many patients, further study is warranted to better define their role in chronic pancreatitis compared with well-established surgical techniques.