Common bile duct strictures associated with chronic pancreatitis

F. E. Eckhauser, J. A. Knol, W. E. Strodel, S. Achem, T. Nostrant

Research output: Contribution to journalArticle

Abstract

Common bile duct (CBD) strictures associated with chronic pancreatitis may cause significant hepatobiliary disease. Nine patients with chronic alcohol-related pancreatitis and CBD obstruction requiring operative biliary or pancreatobiliary decompression are reported. Alkaline phosphatase was the most specific biochemical indicator of cholestasis. Abnormal CBD anatomy was delineated accurately in 89 per cent of cases with percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). All strictures were localized to the intrapancreatic portion of the distal CBD. Pancreatic pseudocysts (PPC) were identified in six (67%) cases. All nine patients underwent biliary decompression. Simultaneous PPC drainage or pancreatic duct decompression (Peustow procedure) was performed in eight cases (89%). No perioperative mortality occurred, and all patients reported subjective improvement in symptoms. Biliary tract strictures sufficient to cause clinical or biochemical cholestasis are a poorly recognized complication of chronic pancreatitis. Cholangiography (PTC or ERCP) should be obtained in order to delineate radiographic features, and extent and severity of the biliary stricture because there is no predictable correlation between levels of serum alkaline phosphatase and liver histopathology. A percutaneous biopsy is requisite to document changes in hepatic morphology. In order to prevent potential hepatobiliary complications such as cholangitis and secondary biliary cirrhosis, biliary strictures should be managed surgically even in anicteric and otherwise asymptomatic patients. Simultaneous treatment of associated pancreatic pathology can be performed if necessary with little added morbidity.

Original languageEnglish (US)
Pages (from-to)350-358
Number of pages9
JournalAmerican Surgeon
Volume49
Issue number7
StatePublished - Sep 23 1983
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Eckhauser, F. E., Knol, J. A., Strodel, W. E., Achem, S., & Nostrant, T. (1983). Common bile duct strictures associated with chronic pancreatitis. American Surgeon, 49(7), 350-358.