<Originals>Jaundice secondary to bile duct stenosis in chronic pancreatitis ; a clinical survey

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Stenosis of the distal segment of the common bile duct (CBDS) due to periductal fibrosis was seen in 22 (18%) of 58 surgical cases of chronic pancreatitis. Eleven of the 22 patients developed obstructive jaundice preoperatively (group JA with total serum bilirubin 13.9±11.2 mg/dl ; mean±SD) and the other 11 had no history of jaundice (group NJ). These two groups were compared with 12 patients with chronic pancreatitis without CBDS (group CO). In the JA group, the average age of patients (59.2±18.8 years) was significantly higher (p<0.01〜0.05) and the interval between the onset of symptoms and operation (1.7±1.2 months) was shorter (p<0.001) than in the other two groups. Five patients had no symptoms other than jaundice, and six cases had idiopathic pancreatitis. Although some liver function tests in the JA group were significantly higher than in the NJ group (p<0.05〜0.001), there was no evidence of cirrhosis. Irregular or occlusive CBDS was visualized in 5 patients of the JA and 3 of the NJ groups by direct cholangiography. In the JA group, seven patients were suspected of having carcinoma at the site of CBDS, and three underwent pancreaticoduodenec-tomy. The other 8 patients were subjected to cholangiojejunostomy. None of the patients in the NJ group underwent prophylactic surgery for CBDS. No further symptoms related to persistent CBDS in patients of either the JA or NJ groups or the development of CBDS in the CO group have been detected during follow-up. Although a bypass operation for CBDS in jaundiced patients with chronic pancreatitis may be safe and reasonable, multiple intraoperative biopsies and logt-term follow-up are mandatory.

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