Cylindrical dilatation of the choledochus: A special type
of congenital bile duct dilatation
Takuji Todani, Yasuhiro Watanabe, Tadashi Fujii, Akira Toki, Sadashige Uemura,
Yoshinobu Koike
Surgery 98: 964-969, 1985
Cylindrical dilatation of the choledochus develops in
20% of patients with congenital bile duct dilatation and usually has acute-angled
unions of the pancreatobiliary ductal system. Symptoms generally develop
in patients over / year of age. The patients frequently complain of abdominal
pain. vomiting. and fever as in those with acute pancreatitis. Ultrasonography
and infusion cholangiography are the most useful tools in making a correct
diagnosis. A high amylase level in the bile caused by the refluxing of pancreatic
juice through anomalous ductal unions is commonly observed. This is responsible
for biliary perforation in infancy and possibly carcinoma arising in the
bile duct. The amylase concentration in the serum at the time of epigastric
pain often is high. which leads to the diagnosis of acute pancreatitis.
However. evidence of pancreatic inflammation is seldom noted. Accordingly.
amylase in the bile may enter the circulating blood through the denuded
epithelium or sinusoids of the liver. Excision of the whole extrahepatic
duct along with hepaticoenterostomy would be essential for the treatment
of cylindrical dilatation of the bile duct. especially when an anomalous
ductal union is present.
Return