Abstract
Idiopathic dilatation of the common bile duct has been consideredas very rare disease, since Vater first reportedin 1723.
In this country, however, it has been frequently encountered. Two hundred and forty two operations were performed on the biliary tract at the Kure National Hospital, Hiroshima, from Jan. 1, 1958 to Dec. 31, 1967, and two patients with this disease were discovered. Outpatients who visited this hospital in the same periods were 121, 770.
The purpose of this paper is to report two cases with idiopathic dilatation of the common bile duct.
Case 1: A male infant, only 4 months of age, complaining of green colored stool and a childhead-sized right abdominal tumor, was admitted for the suspicious retroperitoneal tumor.
The diagnosis had been uncertain before laparotomy. The dilated common bile duct was resected except for the distal portion of this duct for about 3cm., and end-end anastomosis was made between hepatic duct and the rest of common bile duct. Cystic duct was cut-off with gallbladder and anastomosed to the hepatic duct end-side. The gallbladder was fixed to the peritoneum, then a fine vinyl tube was inserted from the surface of the abdominal wall to the duodenum by way of gallbladder, cystic duct, hepatic duct and rest of common bile duct as a external drainage of biliary system. This operative procedure had been successfully performed but he died of biliary peritonitis due to opening of the anastomosed wound between hepatic duct and common duct.
Case 2: A girl, 4 years and 9 months of age, complained of jaundice, right abdominal mass and slight tenderness of the upper abdomen. Laboratory data showed an obstructive jaundice and moderate anemia. Cholecystogram was negative, however, she was stronly suspected as an idiopathic dilatation of the common bile duct from these typical clinical symptoms. The diagnosis was confirmed at laparotomy, and side-side choledocho-duodenostomy was performed. Her postoperative course was uneventful and discharged after 21 days.
