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.
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