ABSTRACT
Two cases of neuroma of the common bile duct (CBD) associated with jaundice and cholangitis both 15 years after cholecystectomy are presented. The surgical treatment, excision of the diseased CBD, followed by Roux-en-Y biliary drainage in one case and excision of the tumor with T-tube drainage in the other, was curative. A review of the world literature revealed 20 prior cases of CBD neuromas, 19 associated with jaundice. None was diagnosed prior to operation or autopsy. Mortality of treatment was 15% and all deaths were associated with a failure to excise the neuroma.
Subject(s)
Common Bile Duct Neoplasms/surgery , Neuroma/surgery , Aged , Anastomosis, Roux-en-Y , Common Bile Duct Neoplasms/pathology , Drainage/instrumentation , Hepatic Duct, Common/surgery , Humans , Jejunum/surgery , Male , Neuroma/pathologyABSTRACT
Intractable epigastric pain associated with nausea and bilious vomiting often follows gastric surgery and has been attributed to reflux of bile and the irritating effects of endogenous bile acids on the gastric remnant. To test the effect of changing bile acid composition of the refluxed material on the symptoms and gastric mucosal histology, 12 patients with symptomatic alkaline reflux gastritis were treated for 1 mo with placebo and for 1 mo with ursodeoxycholic acid, 1000 mg/day. Before treatment, all patients were symptomatic and manifested epigastric pain, nausea, and bilious vomiting. The gastric mucosa was erythematous, friable, and bile stained, and the histology revealed chronic inflammation. No significant change in symptoms was noted during administration of placebo. In contrast, ursodeoxycholic acid treatment resulted in a profound decrease in the intensity and frequency of pain and almost abolished nausea and vomiting. During bile acid therapy the proportion of ursodeoxycholic acid in gastric bile rose to 50% of total bile acids, whereas cholic and deoxycholic acids decreased and chenodeoxycholic acid remained unchanged. The macroscopic and microscopic appearance of the gastric mucosa, however, did not change after 1 mo of ursodeoxycholic acid treatment. These results suggest that increasing the proportion of ursodeoxycholic acid in refluxed gastric bile reduces the pain and frequency of symptoms associated with bile reflux.
