PROTEIN PLUGS CAUSE SYMPTOMS IN PATIENTS WITH CHOLEDOCHAL CYSTS

Objectives: Symptoms in patients with choledochal cysts are believed t o be caused by pancreaticobiliary maljunction. However, this anomaly a lone cannot explain the occurrence of symptoms, The aim of this study was to elucidate the etiology of the symptomatology in patients with c holedochal cysts, Methods: Clinical data and preoperative and operativ e cholangiopancreatography were reviewed in 55 consecutive patients wi th choledochal cysts seen between 1980 and 1996. Results: The bile duc t was significantly larger in the symptomatic phase than in the asympt omatic phase, External biliary drainage resulted in rapid resolution o f symptoms in 11 patients, A radiolucent filling defect in the pancrea ticobiliary duct was found in 22 patients (40.0%). The defects were in the common channel in 15 patients and near the common channel in 7 pa tients, Filling defects disappeared spontaneously or after irrigation in 19 patients, In three patients, the material in the common channel removed during surgery was fragile and consisted of more than 98% prot ein, Conclusion: The filling defects were protein plugs, The simultane ous occurrence of symptoms and signs may be explained by disturbances in bile and pancreatic secretory flow caused by a protein plug in the common channel.