RESUMO
Tipo de estudio: prospectivo, descriptivo, realizado durante el período noviembre 2005 a junio 2006 en el hospital Luis Vernaza, sala Santa Cecilia. Objetivo: conocer la incidencia de las variaciones anatómicas anormales mediante el uso de la técnica de la colangiografía intraoperatoria realizada durante la colecistectomía; determinar la importancia clínica de la ubicación del esfínter de Oddi en el duodeno. Resultados: de un universo de pacientes, de sexo femenino, se obtuvo el siguiente porcentaje de variaciones anatómicas: 47 pacientes cuyo esfínter de Oddi fue ubicado en posición normal, es decir en la segunda porción 8 pacientes en la primera porción del duodeno y 5 en la tercera porción. Conclusión: pacientes que presentaron variedades anatómicas anormales del esfínter de Oddi presentaron cuadro clínico más severo.
Prospective and descriptive carried out from November 2005 to June 2006 at the Luis Vernaza Hospital, Santa Cecilia Room. Objective: to be aware of the prevalence of abnormal anatomic variations through the technique of intraoperative bile duct X-ray carried out during the cholecystectomy; and determine the clinical importance of the location of the Odds Sphincter in the duodenum. Results: in a sample of 60 female patients the following percentages of anatomic variations were found: 47 patients whose Oddis Sphincter was located in a normal second portion. 8 patients in the first portion of the duodenum and 5 of them in the third portion. Conclusion: patients with abnormal anatomic variations of Oddis Sphincter presented a more severe pathological clinical case.
Assuntos
Masculino , Feminino , Colecistite , Esfíncter da Ampola Hepatopancreática/anormalidades , Litíase , Colangiografia , Colecistectomia , Período IntraoperatórioRESUMO
BACKGROUND: The exact cause of recurrent pancreatitis among patients with anomalous pancreaticobiliary union is not known. Sphincter of Oddi dysfunction has been implicated as a mechanism. This study evaluated sphincter of Oddi function in children with anomalous pancreaticobiliary union and recurrent pancreatitis and assessed the results of endoscopic sphincterotomy in the management of this condition. METHODS: We retrospectively reviewed 128 endoscopic retrograde cholangiopancreatographic (ERCP) studies performed on children older than 1 year and adolescents with pancreaticobiliary disease. In 64 instances, ERCP was performed because of recurrent pancreatitis. Nine patients underwent sphincter of Oddi manometry followed by endoscopic sphincterotomy, and these patients were included in this study. A basal pressure greater than 35 mm Hg was considered diagnostic for sphincter of Oddi dysfunction. Follow-up data were obtained retrospectively from the patients' relatives and referring physicians. RESULTS: An anomalous pancreaticobiliary union was found in 18 of 64 (28%) patients with recurrent pancreatitis. The 9 patients who underwent sphincter manometry and endoscopic sphincterotomy were 5 girls and 4 boys 2.9 to 17 years of age (mean 7.8 years). A choledochal cyst was found in 7 of these 9 patients. Two patients had anomalous pancreaticobiliary union without common bile duct dilatation. All 9 patients had sphincter of Oddi dysfunction (mean basal pressure 96 +/- 37.8 mm Hg, range 48 to 156 mm Hg). The length of the common channel was 22.8 +/- 5.5 mm, and the length of the sphincter of Oddi segment was 12.1 +/- 1.9 mm (p < 0.001). In all patients the sphincter of Oddi segment was located within the duodenal wall. The mean follow-up period after endoscopic sphincterotomy was 26.4 months (range 18 to 38 months). Eight patients had excellent results defined as absence of symptoms and no subsequent episodes of acute pancreatitis. Treatment of 1 patient was considered moderately successful because the patient still had occasional pain without pancreatic enzyme elevation but no subsequent episodes of acute pancreatitis. One patient had mild postprocedural pancreatitis. CONCLUSIONS: Recurrent pancreatitis and anomalous pancreaticobiliary union are associated with sphincter of Oddi dysfunction in children and adolescents. Endoscopic sphincterotomy is beneficial to these patients.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco/anormalidades , Ductos Pancreáticos/anormalidades , Pancreatite/congênito , Esfíncter da Ampola Hepatopancreática/anormalidades , Adolescente , Criança , Pré-Escolar , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Manometria , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Pancreatite/diagnóstico por imagem , Recidiva , Esfíncter da Ampola Hepatopancreática/diagnóstico por imagem , Esfíncter da Ampola Hepatopancreática/cirurgia , Esfinterotomia Endoscópica , Resultado do TratamentoRESUMO
En 58 pacientes se ejecutó la ETOB para probar su utilidad en estenosis, coledecolitiasis y en pancreatitis biliar en un período de seguimiento de 14 meses a 11 años tres meses. La ETOB, se llevó a cabo en 33 casos (27 por ciento)por coledocolitiasis. Excepto en un caso, el resto presentaron cálculos en la vesícula o en el colécodo. en 39 pacientes (67 por ciento) con colangiografía previa a la ETOB el diámetro delo colédoco midio en x= 1.6 cm. A las 24 horas y entre el tercer a quinto día por postoperatorio la amilasa y la bilirrubina en sangre disminuyeron indicando el restablecimiento del libre flujo biliopancreático soportado después por la colangiografía postoperatoria con el pasaje rápido del contraste al duodeno y por la disminución significativa del diámetro del colédoco (p menor que 0.05). La morbimortalidad fue de 24.5 por ciento y 1.7 por ciento respectivamente. Los resultados fueron malos en dos casos, regulares en un caso y buenos en 55 (94.6 por ciento) quienes estuvieron libres de síntomas de enfermedad obstructiva biliar a través del seguimiento. Se concluye que la ETOB es útil para restablecer el libre flujo biliar o biliopancreático en casos de estenosis, coledocolitiasis y pancreatitis biliar