Effect of lollipop sucking on the recovery of gastrointestinal function in children after congenital choledochal cyst excision: A randomized controlled trial

This study is aimed to evaluate the effect of lollipop sucking on the recovery of gastrointestinal function in children after congenital choledochal cyst excision.58 children who had undergone congenital choledochal cyst excision were randomly divided into two groups:the controlled group and the experimental group.Children in the experimental group were allowed to suck on strawberry lollipops for 20e30 min once every four hours beginning six hours after the operation.The recovery time of bowel sounds and anal defecation was recorded and compared between experimental and control groups.Compared with the controlled group the recovery times of bowel sounds(41.75±7.38 h vs.51.43±5.02;p<0.001)and anal defecation(64.32±14.69 h vs.79.17±14.91 h;p<0.001)were significantly shorter in the experimental group.Results of the present study indicate that Sucking of lollipops by children after choledochal cyst excision facilitates the recovery of bowel movement and relieves postoperative abdominal distension.

Expressions of p53 and inducible nitric oxid synthase in congenital choledochal cysts

BACKGROUND: Choledochal cyst, an isolated defect un- restricted to the bile duct, is more appropriately regarded as the sentinel feature of a constellation of anomalies affect- ing the pancreatobiliary system. This study was to assess the relationship between the expression of inducible nitric oxide synthase (iNOS) and the p53 gene as well as the pathoge- nesis of choledochal cysts. METHODS: iNOS and p53 were detected by immunohisto- chemistry staining in 26 patients with congenital choledo- chal cysts. Histopathologically, hyperplasia of the mucosa of the cysts and the amylase level in the bile were also inve- stigated. RESULTS: Patients with a high level of amylase in the bile had higher expression of iNOS than those with a low level of amylase. p53 protein was expressed neither in fusiform type nor in cystic type. The incidence of mucosal hyperpla- sia was significantly higher in the fusiform type than that in the cystic type. CONCLUSIONS: Higher expression of iNOS may partici- pate in hyperplasia and carcinogenesis of the mucosa of choledochal cysts. The regurgitation of pancreatic juice in- to the biliary system might induce mucosal hyperplasia of the biliary tract and inflammatory reaction. In preventing regurgitation-caused hyperplasia and malignancy of the bi- liary tract, early surgery is important for children with con- genital choledochal cysts.

Congenital choledochal cysts in adults:twenty-five-year experience

Background Choledochal cyst is rare in western countries. The relatively high incidence of coexistent hepatobiliary disease increases the difficulty of the surgical management of choledochal cyst. Here we analyze the diagnosis and treatment of congenital bile duct cyst in 122 Chinese adults. Methods The clinical data of 122 patients with congenital choledochal cysts admitted from 1981 to 2006 were analyzed. Results Clinical symptoms in most cases were nonspecific, resulting in delayed diagnosis. Sixty-one patients （50%） had coexistent pancreatobiliary disease. Among the 122 patients, 119 patients underwent ultrasonic examination; ERCP/MRCP was performed in 63 cases and CT in 102 cases. Abnormal pancreatobiliary duct junction was found in 48 patients. Sixteen patients had malignant lesions in the bile duct, arising in 11 of them from incomplete choledochal cyst that underwent various operations including cystenterostomy or cystojejunostomy There was significant difference between the patients who underwent incomplete cyst resection and complete cyst resection in malignancy rate of bile duct （Chi square test, P= 0.000; odds ratio, 7.800; 95 % confidence interval, 2.450 to 24.836）. Conclusions ERCP, CT and MRCP had proved their great values in the classification of the disease. Cyst excision with Roux-en-Y hepaticojejunostomy is recommended as the treatment of choice for patients with type Ⅰ or type Ⅳ cysts. For type Ⅴ cyst （Caroli＇s disease） with recurrent cholangitis, liver transplantation should be considered.

Congenital choledochal cyst with pancreatitis

Objective To understand the relationship among congenital choledochal c yst, 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 cho la ngiography was performed in 24 children Pancreatic samples obtained from the h e ad and body of the pancreas at operation were observed under light and electron microscope Serum amylase was analyzed one week before and after operation resp e ctively Bile amylase in the cyst and gallbladder was measured at operation Results The incidence of AJPBD was 70%. Inflammatory cell infiltration and fibro us hyperplasia were seen in the pancreatic specimens of 5 children, of whom 4 ha d AJPBD No ultrastructural changes were found in 2 children without AJPBD, whi l e different changes were seen in 6 with AJPBD, including those showing no pathol ogical changes under light microscope All the changes became more severe as th e age of the patient increased The bile and serum amylase levels were higher in children with AJPBD than those without AJPBD ( P <005) Conclusion Congenital choledochal cyst has a close relationship with AJ PBD and pancreatitis Pancreatic pathological changes have a long and chronic c o urse from ultrastructural changes to macroscopic changes for the developing of p ancreatitis

Narrow portion of the terminal choledochus is a cause of upstream biliary dilatation in patients with anomalous union of the pancreatic and biliary ducts

AIM: To clarify the pathogenesis of biliary dilatation associated with anomalous union of the pancreatic and biliary ducts (AUPBD).METHODS: Direct cholangiopancreatograms of 350 adult patients with or with suspicion of hepatobiliary or pancreatic disorders were reviewed. AUPBD was diagnosed cholangiopancreatographically, when the pancreaticobiliary ductal union was located above the narrow distal segment of the bile duct, which represents the action of the sphincter of Oddi. The narrow portion of the terminal choledochus was defined as symmetrical stricture of the common bile duct just above the pancreaticobiliary ductal union.RESULTS: AUPBD was found in 36 patients. Among cholangiopancreatographic features, the narrow portion of the terminal choledochus was the most pathognomonic for AUPBD (accuracy, 98%); it was present in 29 (81%)patients with AUPBD, but was not found in any patients without AUPBD. Among patients with AUPBD, biliary dilatation (＞10 mm) was more frequent in those with the narrow portion of the terminal choledochus (23/29)than in those without (2/7; P = 0.018) AUPBD. Among the patients with both AUPBD and the narrow portion of the terminal choledochus, there was a strong negative correlation between the minimum diameter of the narrow portion and the maximum diameter of the choledochus (r = -0.78, P＜0.001), suggesting that the degree of biliary narrowing at the narrow portion correlates with that of upstream biliary dilatation.CONCLUSION: The narrow portion of the terminal choledochus, a pathognomonic radiologic feature of AUPBD, may be a cause of biliary dilatation in patients with AUPBD.