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KMID : 0371319660080070406
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Journal of the Korean Surgical Society
1966 Volume.8 No. 7 p.406 ~ p.414
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Idiopathic Dilatation of the Common Bile Duck
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張泰守/Chang, Tae Soo
金斗觀/尹健鎬/李東植/Kim, Doo Kwan/Youn, Kun Ho/Lee, Dong Shik
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Abstract
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Every surgeon who is going on surgery should be acquainted with and bear in mind the various congenital anomalies of the biliary system to avoid the serious surgical complications and lessen the mortality rate.
During recent 6 years (from April 1960 to March 1966) we had experienced three cases of the idiopathic dilatation of the common bile duct (choledochal cyst) which is one of the relatively tare congenital anomaly of the biliary system.
The incidence of our cases was 3 out of 150,000. Two were women and another was man. According to the classification of ´Alonso-Lej et at.´ two were choledochal cysts and one was choledochocele. Pertain to the ago of onset the former two were 26(during 2nd trimester of pregnancy)and 42, and the latter was 30. The all three cases had upper gastro-intestinal tract symptoms such as indigestion, nausea, vomting and epigastric fullness which was thought to be due to compression of the gastro-intestinal tract by the cystic dilation of the common bile duct.
The characteristic clinical triad, RUQ abdoneal pain and papable mass was present in the cases of choledochal cyst.
Though there is no standard diagnostic criteria, increasing interest and awareness of surgeons, clinical triads and symptoms, various roentgenographic studies including upper GI series, oral cholecystogram, Ⅳ cholangiography, are helpful for the diagnosis of this disease pre-operatively. Operative cholangiography must be done as a routine, if possible. It is the most valuable diagnostic clue when surgeon encountered this condition unexpectedly during operation.
The only definitive treatment of this disease is operative. Various operative procedures which designed to establish a bypass of the bile flow into the gastrointestinal canal has been carried out.
Different types of the operative procedures were applied on each of our three cases; choledochocystoduo-denostomy with transient external drainage for one choledocal cyst, side to side choledochocystojchunostomy with Braun´s anastomosis for the other one and side to end choledochojejunostomy (Roux-en Y) for the choledochocele, for whom side to side duodenojejunostomy was added for the prevention of passage disturbance of the duodenum.
Of all three cases the postoperative course was uneventul except that the pregnant woman delivered a premature baby on the third postoperative day. Short term follow up was very satisfactory.
A biopsy taken from one choledochal cyst showed the extensive thickening, fibrosis of the common bile duct and lack of epithelium. There were islands of epithelisum scattered in the fibrotic tissue. The infiltration of polymorphonuclear leukocytes, mononuclear leukocytes and macrophages proved acute and chronic inflammation.
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