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Joseph Yadegar, MD; Russell A. Williams, MD; Edward Passaro, Jr, MD; Samuel E. Wilson, MD

Arch Surg. 1980;115(5):582-586.

Abstract
• Common bile duct stricture secondary to chronic pancreatitis is difficult to detect clinically. Surgical bypass is necessary if complications from biliary obstruction develop. In 21 patients operated on between 1968 and 1979, the earliest typical biochemical finding was a persistently elevated serum alkaline phosphatase level. The SGOT level was minimally elevated in seven patients, but did not correlate with changes in the stricture. An increased bilirubin level was noted either during an acute exacerbation of pancreatitis or late in the course of the stricture development, when obstruction was almost complete. Operative cholangiograms taken in 12 of these patients and transhepatic cholangiograms taken in nine demonstrated a stricture of the intrapancreatic bile duct more than 2 cm long. Operations were performed for treatment of obstructive jaundice (11), ascending cholangitis (three), suspected pancreatic cancer (three), and progressive biliary cirrhosis (two). Sphincteroplasty, initially attempted in four patients, uniformly failed to relieve the obstruction due to the length of strictured duct. Satisfactory drainage was obtained for up to ten years with choledochoduodenostomy (12), choledochojejunostomy (three), and cholecystojejunostomy (six).

(Arch Surg 115:582-586, 1980)

Author Affiliations
From the Surgical Service, Veterans Administration Wadsworth Medical Center, Los Angeles (Drs Yadegar, Williams, Passaro, and Wilson), and the Department of Surgery, University of California, Los Angeles School of Medicine (Drs Passaro and Wilson).

Footnotes
Accepted for publication Aug 7, 1979.

Read before the Third Annual Association of Veterans Administration Surgeons Symposium, Salt Lake City, May 8, 1979.

Reprint requests to Surgical Service (691/112K), Veterans Administration Wadsworth Medical Center, Los Angeles, CA 90073 (Dr Wilson).

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