Stenosis of the lower end of the common bile duct without choledocholithiasis has been recognized for many years. Recent investigations have established that the scarring which produces the stenosis is final and irreversible result of inflammatory changes. Two hundred and forty endoscopic observations of the duodenal papilla were made from July, 1970 to March, 1972, and specimens of periampullary tissue from fifty unselected autopsy cases were used for comparison. This paper is to discuss clinical and pathological findings of the duodenal papilla with inflammatory changes. The results are as follows: 1) In the diseases of the bile duct, especially choledocholithiasis, the size of the papilla becalne bigger than that of the normal one (17.3±2.9mm in longitudinal diameter and 12.1±2.4mm in transverse diameter), showing the types D and D'. 2) In these cases with papilla which showed type D and D', enlargement the intramural portion of the terminal common bile duct was observed on cholangiogramy and on anatomical findings of autopsy specimens. 3) A correlation was shown between the maximum diameter of the bile duct and the size of the papilla in diseases of the biliary tract, and coefficient titer is 0.772. 4) The histological study of biopsy specimens on the papillary region was done, in cases with abnormal papilla (greater than 20mm in diameter) cellular infiltration, proliferation of connective tissue and glandular hyperplasia were markedly observed. 5) We believe that these clinical and pathological findings in diseases of the biliary tract may result from various inflammatory reactions in the duodenal papilla. 6) Swelling of the anatomical papilla was observed in 8 out of 17 cases (47%) with inflammatory change of the duodenum (duodenitis). In twelve out of 16 cases with diseases of the liver the size of the duodenal papilla was almost the same as that on normal one, but in one case (No.6) duodenal papilla was swelling and alkaline phosphatase, leucine aminopeptidase level was high. We believe that the inflammatory stenosis of the terminal part of the common bile duct sometimes due to extension of the inflammation of the duodenum, and that the swelling duodenal papilla may occur keeping jaundice.
The author has fortunately experienced a healthy female volunteer for normal control of indocyanine green (ICG) test who have showed very low disappearance rate (K), which showed 0.031, whereas the other liver function tests were within normal limits including BSP test. It is the purpose of present study to clarify the disturbance of ICG uptake-excretion mechanism in this volunteer. Firstly, ICG (0.5mg/kg), 198Au colloid (5-10 μCi) and 131I-rose bengal (5-10μCi) were injected simultainously for the determinations of disappearance rate (K, KAU and KRB). And then, by the application of the continuous infusion method, ICG was perfused intravenously at the rate of three different infusions, and the estimated maximum rate of biliary excretion (Tm) and the estimated relative hepatic storage capacity (S) were examined. The total number of examinations was 63 in 57 cases with liver diseases. The distribution of K values of these cases were similar to the other reports. Normal values (M & plusmn;SD) for Tm and S were 0.89 & plusmn;0.19 mg/min and 328.5 & plusmn;143.9mg/mg%, respectively. Tm and S were decreased in accordance with the degree of liver damage, and only cases with liver cirrhosis were markedly low in the values of Tm and S. No correlation between Tm and S was observed. The correlation coefficient between K and S (r=+0.79, p<0.005) was higher than that between K and Tm (r=+0.51, p<0.005). K was significantly correlated with KAU at r=+0.49 and KRB at r=+0.80. The values of KAU were within normal range both in Rotor's syndrome and the ICG abnormality case above described, however the discrepancy of KRB (respectively 0.009 and 0.053) such as BSP retention rate and serum bilirubin concentration was observed in these two cases. On the basis of these results, the author suggested that a healthy female with abnormal ICG test had the disturbance of the uptake mechanism and storage capacity of liver cells for ICG.
Forty-nine years old man was admitted to the Okura National Hospital, complaining of tarry stool. Hypotonic duodenography revealed nische and its surrounding filling defect of duodeno-jejunal junction. Endoscopic examination with the fiber-duodenoscope was performed and diagnosed the cancer with bleeding ulcer. The lesion was resected totally and histology was adenocarcinoma.
The 34-year-old man diagnosed as diabetes mellitus complained of a slight fever, a cough and sputa. The origin was not revealed by liver biopsy, laparoscopy and some other clinical ex aminations. But, the percutaneous transhepatic cholangiography (PTC) showed the biliobronchial fistula. The final diagnosis was liverabscess with biliobronchial fistula.