A Case of Localized Extrahepatic Primary Sclerosing Cholangitis

Nobuyasu Suzuki, Tsuyoshi Abe, Takuro Saito, Takao Tsuchiya, Yoshihiro Satoh, Akira Kenjo, Fumihiko Yamada, Fumihiko Ohsuka and Mitsukazu Gotoh

Department of Surgery I, Fukushima Medical University School of Medicine

We report a case of localized primary sclerosing cholangitis (PSC) mimicking bile duct cancer. A 58 year old man admitted for general fatigue was showed in endoscopic retrograde cholangiography to have a narrowed lesion 2.5 cm long localized in the middle and lower bile duct. Endoscopic ultrasonography us showed a thickened wall at the same site. Tests for antinuclear antibody and antimitochondria antibody were negative. We suspected bile duct cancer and primary sclerosing cholangitis (PSC) and conducted a laparotomy. Intraoperative choledochoscopy showed no tumorous lesion in bile duct mucosa and intraductal us showed the thickened inside layer of the bile duct wall. Pathological examination of the thickened wall showed infiltration of inflammatory cells and fibrosis. Liver biopsy showed infiltration of inflammatory cells around the bile duct. We diagnosed this patient as having PSC, based on Weisner's criteria. We resected the extrahepatic bile duct, including the narrowed lesion, and conducted choledochojejunostomy. The patient has been in good health in the 17 months since aurgery.

Key words
localized primary sclerosing cholangitis, intraductal ultrasonography

Reprint requests
Mitsukazu Gotoh Department of Surgery I, Fukushima Medical University School of Medicine
1 Hikarigaoka, Fukushima, 960-1295 JAPAN

Accepted
March 27, 2002

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