Progressive billary pathology associated with common pancreato-biliary channel

A female infant who presented with transient obstructive jaundice and who w as shown to have mild fusiform dilatation of the common bile duct at the ag e of 18 months was followed up with hepatobiliary ultrasound scans over a p eriod of 17 years. Enlarging gallbladder polyps were identified during the last 2 years of follow-up, and endoscopic retrograde cholangio-pancreatogra phy (ERCP) showed a common pancreato-biliary channel with minimal bile duct dilatation. A high concentration of pancreatic amylase was detected in the bile. Hepaticojejunostomy and cholecystectomy were performed. Histological ly, the resected common bile duct showed fibrous thickening of the wall and loss of surface epithelium. Muscular hypertrophy and polypoid lesions, whi ch were foci of cholesterosis, were identified in the gallbladder. There wa s a minimal lymphocytic infiltrate in the subepithelial connective tissue. This report documents a progressive change in the ultrasound appearances of the gallbladder acid histological changes in the extrahepatic ducts second ary to a common pancreato-bilian/ channel and pancreato-biliary reflux. Cop yright (C) 2000 by W.B. Saunders Company.