Traumatic Stenosis of the Biliary Tract with Portal Vein Stenosis Treated by Short-term Percutaneous Transhepatic Endoprosthesis

Sakae Iwakami, Yoshinori Munemoto, Shouji Miura, Yoshirou Kasahara, Tsuyosi Mitsui, Yasuyuki Asada, Yosirou Iida and Masakiyo Fujisawa

Department of Surgery, Fukuiken Saiseikai Hospital

We diagnosed and treated a case of traumatic stenosis of the biliary tract with portal vein stenosis which was sucessfully managed with the use of a tube stent for percutaneous transhepatic endoprosthesis of the biliary tract. A 23-year-old man received a hard blow to his abdomen by a staring wheel of a truck. On the 22nd day after the accident, he began to have a xanthochromtic change of the skin and vomiting and was admitted to our hospital. On admission, mild anemia, impaired hepatic function and jaundice were observed. Abdominal ultrasonography revealed a dilatation involving intrahepatic to common bile duct. Abdominal CT visualized the dilated common bile duct and hematom a extending from the hepatoduodenal mesentery to the superior margin of the pancreatic head. Endoscopic retrograde cholongiography (ERCP) showed a smooth stenosis of the common bile duct 20 mm in length. Angiography revealed a smooth stenosis of the portal vein. From these findings, we made a diagnosis of biliary stenosis due to abdominal blunt trauma. For the purpose of percutaneous transhepatic endoprosthesis of the biliary tract, the intrahepatic bile duct was punctured, and a 7.2 Fr tube stent was placed. Then internal fistulization was achieved by increasing the diameter of the stent to 14 Fr. Adequate flow was confirmed by fluoroscopic imaging. The indwelling biliary tube was removed on the 35th hospital day. Although the case was associated with portal vein stenosis, this improved with hepatic function and absorption of the hematoma surrounding the common bile duct. Since then, the clinical course has been uneventful and the patient is followed on an ambulatory.

Key words
traumatic stenosis of the biliary tract, portal vein stenosis, percutaneous transhepatic endoprosthesis

Reprint requests
Sakae Iwakami, Department of Surgery, Kanazawa Nishi Hospital 77 Kitamachi kou, Kanazawa, 920-0055 JAPAN

Accepted
December 9, 1998

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