Document Detail

Under pressure: choledochal malformation manometry.
MedLine Citation:
PMID:  15750925     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The cause of choledochal (cystic or fusiform) malformation is not known. A favoured hypothesis suggests that abnormal reflux of activated pancreatic secretions via a common pancreatobiliary channel may initiate mucosal injury and mural weakness leading to bile duct dilatation, at normal intraduct pressures. However, bile duct pressures in both normal or disease states are not known in such children. METHODS: Intraoperative choledochal pressure (CP) measurements were made before any other manipulation. Bile was cultured and its amylase content measured. Biochemical liver function (bilirubin, aspartate aminotransferase, gamma-glutamyl transpeptidase, and alkaline phosphatase) was measured. Data were quoted as median (interquartile range). Statistical tests were parametric, where appropriate, and P = .05 was regarded as significant. RESULTS: Twenty-five children (age 2.5 [1.25-5.91] years) with choledochal (cystic [n = 13] and fusiform [n = 12]) malformation coming to surgery were studied. Median CP was 13 (8.5-17) mm Hg. Median bile amylase was 6722 (241-18,000) IU/L. Choledochal pressure inversely correlated with bile amylase (r = -0.60, P = .001), serum aspartate aminotransferase (r = 0.46, P = .01), and log gamma-glutamyl transpeptidase (r = 0.4, P = .04) but not with bilirubin (P = .11), alkaline phosphatase (P = .20), or age (P = .11). No difference in CP, bile amylase, or liver biochemistry could be identified between the 2 biliary phenotypes. All bile cultures were sterile. CONCLUSIONS: Increased CP is inversely related to the level of bile amylase (and hence degree of the functional common channel). This suggests that obstructive stenosis at the level of the pancreatobiliary junction (but not the ampulla) may be a causal factor in a proportion of choledochal malformations.
Mark Davenport; Raj Basu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  40     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-03-07     Completed Date:  2006-02-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  331-5     Citation Subset:  IM    
Department of Paediatric Surgery, Kings College Hospital, SE5 9RS London, UK.
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MeSH Terms
Alkaline Phosphatase / analysis
Amylases / analysis
Aspartate Aminotransferases / analysis
Bile / chemistry,  enzymology
Bile Ducts, Extrahepatic / abnormalities*,  physiopathology*
Bilirubin / analysis
Child, Preschool
Choledochal Cyst / physiopathology*
Cholestasis / physiopathology
Dilatation, Pathologic / physiopathology
Statistics, Nonparametric
gamma-Glutamyltransferase / analysis
Reg. No./Substance:
635-65-4/Bilirubin; EC; EC Aminotransferases; EC Phosphatase; EC 3.2.1.-/Amylases

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