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Congenital choledochal cyst with pancreatitis
1Department of Pediatric Surgery, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China. pub@hbah.he.cninfo.net
Insights
Congenital choledochal cysts are closely linked to anomalous pancreaticobiliary duct junctions (AJPBD) and pancreatitis in children. Pancreatic changes progress over time, from subtle to visible, increasing with age.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Pathology
Background:
- Congenital choledochal cysts are rare biliary tract malformations.
- Anomalous junction of the pancreaticobiliary duct (AJPBD) is a recognized complication.
- Pancreatitis can occur in children with choledochal cysts.
Purpose of the Study:
- To investigate the association between congenital choledochal cysts, AJPBD, and pancreatitis.
- To characterize pancreatic changes in children with choledochal cysts.
Main Methods:
- Study included 25 children (2 months–14 years) with choledochal cysts.
- Intraoperative cholangiography, pancreatic tissue microscopy (light and electron), and amylase level analysis were performed.
- Bile and serum amylase levels were measured pre- and post-operatively.
Main Results:
- AJPBD was present in 70% of patients.
- Pancreatic inflammation and fibrosis were observed in 5 children, predominantly those with AJPBD.
- Higher bile and serum amylase levels were noted in children with AJPBD (P < 0.05).
Conclusions:
- Congenital choledochal cysts are strongly associated with AJPBD and pancreatitis.
- Pancreatic pathological changes develop chronically, progressing from ultrastructural to macroscopic alterations.
- Early detection and management of AJPBD may be crucial in preventing pancreatitis.
Objective:
To understand the relationship among congenital choledochal cyst, anomalous junction of pancreaticobiliary duct (AJPBD) and pancreatitis.
Methods:
25 children with choledochal cyst treated in our hospital were included in this study. Their ages ranged from 2 months to 14 years. Intraoperative cholangiography was performed in 24 children. Pancreatic samples obtained from the head and body of the pancreas at operation were observed under light and electron microscope. Serum amylase was analyzed one week before and after operation respectively. Bile amylase in the cyst and gallbladder was measured at operation.
Results:
The incidence of AJPBD was 70%. Inflammatory cell infiltration and fibrous hyperplasia were seen in the pancreatic specimens of 5 children, of whom 4 had AJPBD. No ultrastructural changes were found in 2 children without AJPBD, while different changes were seen in 6 with AJPBD, including those showing no pathological changes under light microscope. All the changes became more severe as the age of the patient increased. The bile and serum amylase levels were higher in children with AJPBD than those without AJPBD (P < 0.05).
Conclusion:
Congenital choledochal cyst has a close relationship with AJPBD and pancreatitis. Pancreatic pathological changes have a long and chronic course from ultrastructural changes to macroscopic changes for the developing of pancreatitis.