Q) Not true about recurrent pyogenic cholangitis :
a) Mostly there are intrahepatic strictures with involvement of the left side duct
b) It can present as choledocho duodenal fistula
c) There is complete biliary obstruction which leads to marked jaundice and pruritis
d) MRCP and other other cholangiography can be diagnostic
In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked. RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.
Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.
It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.
MRCP can be diagnostic and is preferred because of its non invasive nature.
Q) True about Beger procedure for chronic pancreatitis
a) Posterior branch of gastro duodenal artery is preserved.
b) Beger procedure is a pancreatic head mass resection that can be done for small pancreatic tumors.
c) Intra pancreatic, choledochal and ampullary structures are removed.
d) Neck of the pancreas is not transected
Answer a) Posterior branch of GDA is preserved
Beger procedure for chronic pancreatitis is mostly done in Europe. Hans Beger in 1972 in Germany introduced this for chronic pancreatitis with inflammatory head mass. This is a complex procedure which removes head of the pancreas but leaves duodenum, a thin rim of pancreas around the medial aspect of duodenum and intrapancreatic bile duct intact.
The difference from similar Frey's procedure is that in Beger procedure neck of the pancreas is transacted where as in Frey, neck of the pancreas is not cut.
This procedure is not recommended if there is suspicion of carcinoma head of pancreas and Whipple is the procedure for that For Small tumors it can be used
Posterior branch of GDA is preserved in Beger Procedure.
Reconstruction is at two places: Distal pancreas and rim of the pancreas at medial side of duodenum.