Scientific Papers
Late bile duct cancer complicating biliary-enteric anastomosis for benign disease

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Abstract

Background: Anastomosis between the biliary tree and the intestinal tract has been, and is, a relatively common procedure. Aside from cholangitis secondary to anastomotic stricture, it is generally regarded as innocuous.

Methods: The recent experience with 3 patients who developed bile duct cancer many years after biliary-enteric anastomosis for benign disease prompted a review of whether the procedure was potentially carcinogenic.

Results: There have been very few reports of late cholangiocarcinoma complicating this surgery for benign disease. However, there is some experimental evidence to support the hypothesis, and the time interval between surgery and the development of malignancy may be important.

Conclusions: Reflux of duodenal or small intestinal contents into the biliary tree causes changes in the biliary epithelium that may be adaptive to the new environment but also have the potential to progress to malignant transformation.

Section snippets

Clinical material

Three female patients who had undergone biliary-enteric anastomosis for iatrogenic bile duct injury many years before presented with biliary tract problems without preceding clinical or biochemical evidence to suggest an anastomotic stricture. The Table 1summarizes the relevant details of the 3 patients. Each biliary-enteric anastomosis was patent on preoperative investigations and confirmed on the resected specimen in patients 1 and 2, in whom radical choledochectomy and liver resection were

Comments

The occurrence of cholangiocarcinoma of the bile ducts following long-term choledocho-enteric anastomosis may have been purely coincidental but raises the possibility that direct connection between the intestinal tract and biliary tree could be a predisposing factor. There have been three reports of cholangiocarcinoma as a late complication of choledocho-enteric anastomosis for benign disease where a premalignant process was not evident.1, 2, 3 The malignancy developed 9 to 17 years after

References (17)

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