T. Arendt et al., Gallstones, the choledochoduodenal junction and initiation of acute pancreatitis: are two stones the culprits rather than one stone?, MED HYPOTH, 54(4), 2000, pp. 570-573
Citations number
20
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Reflux of biliary secretions into the pancreatic duct following gallstone o
bstruction of the common biliary pancreatic ampulla has been implicated as
a cause of acute pancreatitis. However, the pancreatic duct pressure is hig
her than the biliary pressure and, therefore, the simple obstruction of the
choledochoduodenal junction by one gallstone does not result in biliary pa
ncreatic reflux. We propose a mechanism whereby simultaneous migration and
sequential impaction above and below the common biliary pancreatic ampulla
of two gallstones allows for the creation of a toxic bile-pancreatic juice
mixture in the common bile duct, subsequent reversal of the pressure gradie
nt and reflux of the toxic secretions into the pancreatic duct. (C) 2000 Ha
rcourt Publishers Ltd.