cbd stricture

Cbd stricture

Benign, single, non-traumatic inflammatory strictures of the biliary tracts were infrequently reported with the exception of primary sclerosing cholangitis[1-3]. Indeed, many benign nontraumatic inflammatory strictures of the common bile duct have been generally considered to be a variant of primary sclerosing cholangitis although Standfield et al[13] described 12 cases of benign strictures of unknown etiology, and differentiated them from the localized form of sclerosing cholangitis. Other inflammatory conditions of the CBD which are potential etiological factors included bacteria or virus infection, parasite infestation, abdominal trauma, congenital abnormality[14], chronic pancreatitis[15], inflammatory pseudotumors[16], complication of chemotherapy[17], complication of duodenal ulcer disease[18-20], and sclerosing therapy of bleeding duodenal ulcer[21]. Most benign segmental strictures of the extra-hepatic bile duct reported in the literature were located at the hilum or distal CBD. Few cases in the mid CBD have been reported.

Correspondence to: Dr. Tseng-Shing Chen, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 112, Taiwan, China. [email protected]

Benign nontraumatic inflammatory stricture of the common bile duct (CBD) may result in obstructive jaundice, which can be misdiagnosed as a malignant tumor of the CBD preoperatively. Two cases with strictures of the mid portion of the common bile duct presenting with obstructive jaundice are reported herein. Preoperative radiological studies prompted us to confidently make the diagnosis of cholangiocarcinoma. However, the postoperative diagnosis on histological examination of the resected lesions was chronic inflammation and fibrosis. The complications of chronic duodenal ulcer are considered as the etiology of these two disorders.

Annular lesion in the mid portion of CBD disclosed in MRI (coronal view).

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Case 2

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A 70 year-old male who had a 10-year history of hypertension and type 2 diabetes mellitus was presented to our hospital. He had tea-colored urine and yellowish skin discoloration for about 2 wk. No abdominal pain or body weight loss was reported. The physical examination was unremarkable except icteric sclera. A complete blood count was within normal limits.

According to the clinical history and surgical findings, stricture of the CBD owing to fibrous encasement by chronic inflammatory changes due to an adjacent duodenal ulcer in these 2 cases was considered. Duodenal ulcer disease is a common disorder, and its associated complications such as hemorrhage, gastric outlet obstruction and perforation, are well known. However, the biliary complications of duodenal ulcer disease, such as biliary-enteric fistula or partial obstruction of the CBD were rare and less well-known[18-20], especially after the worldwide use of effective antisecretory agents, H2-receptor antagonists and proton pump inhibitors.

Abstract

Segmental strictures of CBD demonstrated in percutaneous cholangiogram, ERCP and MR cholangiogram. A: Segmen-tal narrowing of CBD below the insertion site of cystic duct in percutaneous cholangiogram; B: Segmental stricture of CBD with dilatation of intrahepatic bile ducts demonstrated in ERCP; C: Segmental stricture of CHD demonstrated in ERCP; D: Segmental narrowing of CHD and dilatation of the intrahepatic bile ducts demonstrated in MR cholangiogram.

Malignant bile duct strictures are mainly the result of cancer of the ampulla of Vater, pancreas, or bile duct, and account for most patients presenting with obstructive jaundice secondary to extra-hepatic bile duct stricture. Benign non-traumatic inflammatory strictures of the extra-hepatic bile duct are extremely rare with the exception of primary sclerosing cholangitis[1-3]. Most benign strictures reported in the literature are located in the hepatic hilum[4] or distal common bile duct (CBD). Here we report two cases of benign nontraumatic inflammatory strictures of the mid portion of the CBD with painless obstructive jaundice. They were confidently diagnosed as cholangiocarcinoma by radiological studies preoperatively.

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Cbd stricture

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StatPearls [Internet].

Bile duct strictures are segments of the narrowing of the intrahepatic or extrahepatic biliary ductal system. The narrowing impedes the normal antegrade flow of bile, causing proximal dilatation resulting in significant morbidity from the clinical and pathological sequelae of biliary obstruction. The management of these strictures depends on the etiology, which could be benign or malignant. This activity reviews the evaluation and management of bile duct strictures and highlights the role of the interprofessional team in evaluating and treating patients with this condition.

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Computed tomography (CT) scan has higher sensitivity than trans-abdominal ultrasound for biliary malignancy, and its utility can be improved with the use of a multi-detector CT (MDCT) scan and CT-pancreatic protocol in providing more information on tumor vascular encroachment and biliary tree obstruction. It is also able to detect complications from biliary obstruction such as cholangitis and abscesses.[1]