INNERVATION PATTERNS IN CONGENITAL BILIARY DILATATION

The innervation of choledochal cysts was studied to see if the distrib ution of innervating ganglion cells can be utilized as a possible indi cator of the damage and dilatation process of choledochus. Specimens f rom 32 patients aged 1 month to 12 years were stained by the immunoper oxidase method with neural tissue-specific antibodies, the innervating ganglion cells were counted and their number was correlated with the clinical severity patient's age-at-surgery, and intraoperative cholang iographic and/or ERCP findings. In cystic dilatation, the total number of ganglion cells within the choledochal wall was significantly lower than in control specimens regardless of the diameter of the choledoch al cyst, age-at-surgery, or clinical course. In fusiform dilatation, t he total number of ganglion cells varied according to the severity of the clinical presentation, and the diameter of the fusiform choledochu s increased in proportion to the patient's age-at-surgery. The distrib ution of innervating ganglion cells is thought to correlate quantitati vely with the damage and dilatation process responsible for the choled ochal cyst. These results may support a hypothesis that the pathogenes is of cystic dilatation proceeds antenatally or soon after birth, whil e that of fusiform dilatation begins after birth.