J.Jpn. Surg. Soc.. 61(9): 1244-1260, 1960
Original article
SURGICAL FEATURES AND HISTOLOGICAL FINDINGS OF THE LIVER ON CONGENITAL OBSTRUCTION OF THE BILE DUCTS
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Department of Surgery, Faculty of Medicine, Tohoku University, Sendai (Director : Prof. S-T. Katsura) Sozo SUZUKI |
Operatively it will be proper to classify in 4 types for congenital atresia of the bile ducts, and this classification is supported by the postoperative course and histological findings of the hilus of the liver.
The histological investigation of the liver reveales biliary cirrhosis, and in addition there are multinucleated giant cells which are formed by the fusion of degenerated liver cells, intralobular miliary abscess and inhibited growth of intrahepatic bile ducts.
In surgical clinical observation, there are icterus, hepatomegaly, acholic stool, splenomegaly and ascites. There are also anemia and decrease of prothrombin activity. The icterus index is high. In the protein fraction, albumin lowered and α and γ-globulin elevated. In general, the liver function is moderatelly impaired.
It is important to differentiate with infantile hepatitis.
For this, I emphasize to observe the consistency of the liver and to make observation of the clinical progress.
When the stenosis is in the D. choledochus or D. hepaticus, the operative method is to anastomose between the bile duct and the intestine, in case such a big bile duct is absent, the operation should be port-enterostomy. To prevent the ascending infection, the best result is noted when the anastomosing site is by-passed. Among 27 cases, there are 4 cases of complete recovery.
Many etiologic factors are described in the literature, but in my opinion the etiology is not of a single one but of many, such as extrahepatic cholangitis, virus hepatitis in fetus and as Ylppö stated the arrest of development of epithelial concrescence.
(Author's abstract)
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