PANCREATIC ENLARGEMENT IN OBSTRUCTIVE-JAUNDICE - EFFECTS OF BILIARY STREAM DIVERSION IN HUMANS

To verify the influence of obstructive jaundice on pancreatic growth, the anteroposterior width of the pancreas was measured by computed tom ography in 30 cholangiocarcinoma patients excluded patients with dista l bile duct tumor (jaundice group) and 74 control subjects. Follow-up examinations were performed on 12 patients with and without internal b iliary drainage to elucidate the temporal relationship between pancrea tic enlargement and the diversion of the obstructed biliary stream. Hi stologic analysis on autopsy samples from 13 control and 10 jaundice c ases also was performed. Mean pancreatic head and body widths in the j aundice group were 2.93 +/- 0.3 cm and 2.01 +/- 0.3 cm, respectively. These values were significantly greater than those of the controls (2. 13 +/- 0.3 cm and 1.49 +/- 0.3 cm, P < 0.01). The glandular widths ret urned to their normal sizes following internal biliary drainage. No ch anges were seen in patients who underwent external drainage alone. His tologic examination revealed that enlargement of the acinar cells or o f the islet of Langerhans was often seen in the jaundiced patients. Th erefore obstructive jaundice is thought to cause pancreatic growth thr ough a trophic effect by interrupting biliary circulation.