Pseudopancreatitis in Choledochal Cyst in Children: Intraoperative
Study of Amylase Levels in the Serum
Takuji Todani, Naoto Urushihara, Yasuhiro Watanabe, Akira Toki, Sadashige
Uemura, Yasuhisa Sato, Yoshiki Morotomi
J Pediatr Surg 25: 303-306, 1990
A case of acute necrotizing pancreatitis in association
with choledochal cyst is presented. Pancreatitis associated with choledochal
cyst is probably caused by a biliary reflux into the pancreatic duct via
a pancreatobiliary malunion. as the intraductal pressure of the cyst exceeds
that of the pancreatic duct. Ampullar stenosis due to gallstones or inflammatory
changes may increase the intraductal pressure. Bile with activated pancreatic
enzymes refluxes into the pancreatic duct. and possibly results in acute
pancreatitis. However. patients with choledochal cyst presenting with recurrent
bouts of abdominal pain. vomiting. and fever have often been diagnosed as
having acute pancreatitis because of hyperamylasemia. despite no evidence
of pancreatitis at the time of surgery. At the time of bouts. they also
show a slight elevation of serum bilirubin. and an increase in the degree
of the choledochal dilatation that are possibly caused by biliary obstruction.
not ampullar obstruction. due to suppurative cholangitis. The term "fictitious
pancreatitis" or "pseudopancreatitis" in choledochal cyst
appears to be appropriate. This clinical study shows that amylase in the
biliary tract has ready access to the blood stream. probably through a sinusoidal
pathway by cholangiovenous reflux. and a lymphatic pathway. via the Disse's
space and denuded cyst wall. provided the biliary ductal pressure is increased.
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