J.Jpn. Surg. Soc.. 61(9): 1219-1227, 1960

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Original article

HISTOPATHOLOGICAL STUDIES ON THE DUODENAL MAJOR PAPILLA IN CASES OF BILIARY TRACT DISEASES WITH DILATATION OF THE COMMON DUCT.

Histopathological studies were made on twenty-two duodenal papilla specimens obtained by anterolateral papillectomy in the cases of biliary tract diseases with dilatation of the bile ducts. Of these twenty-two cases, six were choledochal stones, eight non-calculous biliary tract disease and the remainenig eight recurrent biliary symptoms after cholecystectomy. The results obtained in the present studies are as follows:
The most distinctive finding as compared with the histologic appearance presented by the normal specimen taken at autopsy showed increased fibrous connective tissue in the sphincter muscle, considerable increase of fibrous connective tissue in the intermuscular connective tissue, and increased fibrous connective tissue and destruction of elastic fibers in the fibrous tissue layer of the terminal part of the common duct. These changes are conspicuous in all cases regardless of kind of the disease described above. Thus histopathological changes may be summerized in a word: papillitis chronica fibrosa.
As the other particular finding, hypertrophy of the sphincter of Oddi in eight cases, remarkable infiltration of eosinocyte in eighteen cases and in many cases atrophy of the mucous gland of the common bile duct were observed.
From the results mentioned above, the author presumes that these histopathological changes may be a cause of functional disorder of the sphincter of Oddi and partial obstruction of the end of the common bile duct at the sphincter of Oddi resulting from biliary stasis, intraductal hyperpressure and finally dilatation of the bile duct. Furthermore at this point, the author believes that these changes may produce ascending infection, reflux of the bile into the pancreatic duct and may form stones in the bile duct which are observed frequently in this country. Because of remarkable infiltration of eosinocyte demonstrated in the most cases of these patients, the author suggested that there are seen a close relationship between the biliary tract disease and the intestinal parasite in Japanese.
(Author's abstract)

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