Transient obstruction of the common bile duct following its exploration

Failure of the contrast medium to enter the duodenum during the operative cholangiography following the common bile duct exploration and instrumentation may be caused by transient obstruction of the common bile duct. It is attributed to spasm and oedema of the sphincter choledochus of Boyden and not of the sphincter of Oddi. The knowledge of the possibility of the pseudo-obstruction of the common bile duct following its exploration may save the surgeon from unnecessary re-exploration and performing sphincterotomy or choledochoduodenostomy. The exploration is unnecessary if, during the common duct exploration, the dilators and the catheter passes easily into the duodenum and on the cholangiogram the obstructed area is smooth and there is no filling defect. A normal cholangiogram performed 8-10 days following the operation proves that the obstruction was transient and not caused by calculus stricture or tumour.

Selective massive amyloidosis of small intestine

A patient with intestinal amyloidosis with perforation was successfully treated by resection of almost the whole involved small intestine and is recuperating on hyperalimentation therapy. Because there were no signs of amyloiditic deposition in other parts of the body and no other cause of the amyloidosis, the case was considered to be selective localized intestinal amyloidosis. This is the third reported case of perforated amyloiditic intestine and apparently the first case of selective small intestinal amyloidosis involving such a complication.