title: Biliary complications of pancreatic necrosis.
abstract: BACKGROUND
  Involvement of the biliary tract in pancreatic necrosis is rare. The authors are presenting six patients with this unusual complication.
  
  
  METHODS
  Retrospective analysis of a case series.
  
  
  RESULTS
  The necrotic process involved the bile duct in four patients (bile duct alone in two and bile duct with duodenum in two) and the gall bladder in two patients. It was not possible to make a preoperative diagnosis of biliary tract involvement in any of these patients. The lesions in the biliary tract were caused by the direct erosion by the necrotic tissue in five patients, and in one patient with gangrene of the gall bladder, it was a "remote" complication of the necrotizing process. All patients underwent surgery. Necrosectomy and cholecystectomy were performed in patients with gall bladder lesions, and proximal biliary drainage was the method of choice in patients with erosion of the bile duct. One patient died postoperatively. During follow-up, another patient who had bile-duct involvement developed a stricture in the damaged part of the bile duct and needed hepaticojejunostomy
  
  
  CONCLUSIONS
  Necrotizing pancreatitis can involve the biliary tract, both by direct extension and by its secondary effects. Although cholecystectomy is the treatment of choice in the presence of gallbladder involvement, proximal biliary diversion may be indicated in patients with erosion of the bile duct.
authors.affiliation: Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital, New Delhi, India. adarsh@nda.vsnl.net.in
authors.forename: A
authors.initials: A
authors.lastname: Chaudhary
authors.forename: A
authors.initials: A
authors.lastname: Sachdev
authors.forename: S
authors.initials: S
authors.lastname: Negi
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D002758:Cholangiography; D002763:Cholecystectomy; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000601:surgery; D005734:Gangrene / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000601:surgery; D012189:Retrospective Studies