Recurrent pancreatitis and jaundice: report of a case in an eleven-year-old girl

An 11-year-old girl had recurrent pancreatitis and jaundice caused by fusiform dilatation of the common bile duct, a variant of choledochal cyst. The treatment was Roux-en-Y choledochojejunostomy and cholecystectomy. There has been no recurrence of symptoms during subsequent follow-up.

Percutaneous transhepatic cholangial drainage: direct approach under fluoroscopic control

We devised a direct percutaneous transhepatic cholangial drainage under fluoroscopic control. The principle is as follows. After percutaneous transhepatic cholangiography, the three dimensional structure of intrahepatic bile ducts is projected to a two dimensional plane under fluoroscopy; the needle can then be introduced into the selected bile duct with accuracy. The technique can be used as a preoperative management of operations of patients with jaundice and also as a palliative management of advanced cancer without much complication.

Unusual manifestations of pancreatic pseudocysts and their surgical management

Six cases representing selected complications of pancreatic pseudocyst are reported and their surgical management is discussed. Patients with mediastinal extension of a pseudocyst frequently present with symptoms in the chest rather than in the abdomen. Chronic recurrent pleural effusion, rich in protein and amylase, often accompanies mediastinal extension of a pancreatic pseudocyst. It is important to recognize that such an effusion almost certainly represents disruption of the pancreatic duct with formation of a pancreatic pseudocyst or a pancreaticopleural fistula. Internal drainage from below the diaphragm is the treatment of choice for pancreatic pseudocysts extending into the mediastinum. To be certain that obstructive jaundice is due to a pancreatic pseudocyst, there must be operative demonstration of compression of the common bile duct by the pseudocyst, relief of the obstruction by surgical drainage of the cyst, and subsequent disappearance of jaundice. Cysts that cause jaundice are located in the head of the pancreas, and cystoduodenostomy is the treatment of choice. Intraperitoneal rupture has been associated with a high mortality, but with adequate fluid replacement, prompt evacuation of the cyst contents from the peritoneal cavity, and adequate drainage, mortality can be lowered. Pancreatic ascites is much more common than is generally supposed and may result from a leaking pancreatic pseudocyst. In contrast to cirrhotic ascites, pancreatic ascites produces elevation of both the serum amylase level and protein concentration. Massive hemorrhage from pancreatic pseudocysts is usually due to the development of a false aneurysm in a branch of the celiac axis in the wall of the pseudocyst, with subsequent rupture of the aneurysm into the gut or peritoneal cavity. Any patient with a pancreatic pseudocyst who shows signs of bleeding should have prompt arteriography for determination of the bleeding site and appropriate surgical control. Pancreaticobronchial fistula is a rare complication. Treatment should be directed toward adequate drainage of the pseudocyst in the abdomen.

Diurnal changes of bile lipid concentration in hepatic bile of cholecystectomized man

Diurnal variations of bile lipid concentration were studied in ten patients with a tube in the main bile duct following a cholecystectomy. 5-6 bile samples per 24 h were collected from each patient during 3-40 days. The enterohepatic cycle was not significantly modified since total bile samples did not exceed 40 ml/day. Significant diurnal variations were observed in cholesterol concentration. Changes in lecithin concentration seemed to be similar in seven patients but did not reach the level of significance in any individual patient. Maximal values were observed between 4 and 8 a.m. and minimal values at 4 p.m. Bile salt concentration varied without any circadian periodicity. Mean bile lipid concentration was calculated for each patient. The patients with highest cholesterol concentrations have also the highest mean lecithin concentration. Mean bile salt concentration does not differ much from one patient to another.