Hepatic histopathological changes in biliary pancreatitis.

OBJECTIVES

Elevation of serum transaminase has been shown to establish gallstone etiology in acute pancreatitis, but little has been reported regarding hepatic histopathological changes in biliary pancreatitis. The main purposes of this study were to observe hepatic histopathological changes in the acute stage of biliary pancreatitis and to elucidate the mechanism of transaminase elevation.

METHODS

Microscopic findings for liver biopsy specimens (26 patients) as well as gross pathological observations of the biliary tract at emergency operation were analyzed in 62 patients with biliary pancreatitis.

RESULTS

The main light microscopic findings were hepatocyte necrosis (96.2%) and acute cholangitis (65.4%). The main electron microscopic findings (two patients) were disorganized liver cell plate, retention of biliary material in the dilated canaliculi, and shedding of cytoplasm into the space of Disse in some areas. At laparotomy, impacted and floating bile duct stones were found in 35 (56.5%) and 13 (21.0%) patients, respectively, and acute inflammatory biliary diseases were encountered in 43 (69.4%) patients.

CONCLUSIONS

The main hepatic histopathological changes in biliary pancreatitis were acute inflammatory hepatocyte necrosis, hepatocyte degeneration, and acute cholangitis caused by ampullary stones impacted during their transpapillary passage. Serum transaminase elevation might be a reflection of hepatocyte necrosis and/or degeneration.