Etiological Concepts on Pancreatitic Symptoms Associated With Congenital Biliary Ductal Dilatation : Report of an Infantile Case

Abstract

Pancreatitic symptoms such as nausea, vomiting, fever, abdominal pain or hyper-amylasemia are somtimes associated with congenital biliary ductal dilatation(CBD) in infancy. The symptoms are thought to be attributed to acute pancreatitis due to reflux of bile into the pancreatic duct caused by the coexisting anomalous choledocho-pancreatic junction. We recently encountered 5-year-old girl with CBD who underwent an external drainage of the common bile duct because of severe pancreatitic symptoms with progressive dilatation of choledochal and pancreatic ducts. The patient underwent cyst excision, cholecystectomy and Roux-en-Y hepaticojejunostomy 1 month after the external drainage. We could detect a considerable amount of phospholipase A_2 and lysolecithin in contents of the common bile duct. These harmful substances seem to act not only on the pancreas but on the biliary ducts, both of which possibly cause pancreatic symptoms in the course of CBD.