Guivarc'h M, Benhamida F
J Chir (Paris). 1976 Oct;112(4):237-52.
The authors report a case of so-called short common bile duct or highly implanted common bile duct, associated with double duodenal ulcer, with an unfavourable course in a very young girl. The pathological characteristics and the course suggested it was a congenital case of short bile duct, which is a rare disease, as 37 cases have been reported over a period of 25 years. 32 were associated with duodenal ulcer, which is often resistant to medical treatment, and becomes complicated in 33% of cases. The relationship between the two conditions remains hypothetical. Biliodigestive reflux was the first sign in 66% of cases. Retrograde opacification of the bile ducts under duodenoscopy should permit a diagnosis and precise pre-operative assessment. The abnormality has no special treatment, but the treatment of the associated disease, of the ulcer in particular, should be adapted to the ectopic bile duct to avoid serious injury. At operation, careful examination before dissection will determine the [site] of the papilla and of the opening of the biliary and pancreatic ducts. Vagotomy should be associated with a drainage operation, if possible, or gastrectomy may be performed with gastro-jejunal anastomosis leaving behind the posterior ulcer. Many precautions are necessary including the duodenal stump and details of these are given here.
作者报告了一例所谓的胆总管短或胆总管高位植入病例，该病例伴有十二指肠溃疡，发生在一名非常年轻的女孩身上，病情发展不利。病理特征和病程表明这是一例先天性胆总管短病例，这是一种罕见疾病，在25年期间仅报告过37例。其中32例伴有十二指肠溃疡，这种溃疡往往对药物治疗有抵抗性，33%的病例会出现并发症。这两种情况之间的关系仍然是假设性的。66%的病例中胆汁反流是首发症状。十二指肠镜检查下胆管逆行显影应有助于诊断和精确的术前评估。这种异常情况没有特殊治疗方法，但对相关疾病，尤其是溃疡的治疗，应根据异位胆管情况进行调整，以避免严重损伤。手术时，在解剖前仔细检查将确定乳头以及胆管和胰管开口的[位置]。如果可能的话，迷走神经切断术应与引流手术联合进行，或者可进行胃切除术并做胃空肠吻合术，保留后壁溃疡。包括十二指肠残端在内有许多注意事项，此处给出了详细说明。
