Ischemic Biliary Stricture following Pancreaticoduodenectomy: Report of a Case and Review of the Literature

Shigenori Nagakura, Yoshio Shirai, Toshifumi Wakai, Naoyuki Yokoyama and Katsuyoshi Hatakeyama

Division of Digestive and General Surgery, Niigata University Graduate
Shool of Medical and Dental Sciences

We report a case of ischemic biliary stricture following pancreaticoduodenectomy (PD). A 47-year-old man who had undergone PD for mucinous cystadenocarcinoma of the pancreas, during which the bile duct was transected at the level of the middle bile duct, presented with obstructive jaundice 7 months after the PD. Percutaneous transhepatic cholangioscopy showed both a pinhole stricture of the common hepatic duct just above the hepaticojejunostomy and intrahepatic gallstones. Histology of endoscopic biopsy specimens of the stricture showed no malignant tissue, leading to a diagnosis of benign biliary stricture with resultant hepatolithiasis. Although endoscopic gallstone retrieval was successful, endoscopic biliary dilation failed. At laparotomy, the common hepatic duct was densely fibrotic. We resected the fibrously thickened duct followed by bilioenteric anastomosis. The resected specimen showed histologically dense fibrous tissue with chronic inflammatory infiltrates, compatible with ischemic biliary stricture. This case and a review of the literature indicate that the bile duct was transected at the upper bile duct and back-bleeding from the transected ductal end, which ensures sufficient arterial blood supply, should be checked when in PD to prevent postoperative ischemic biliary stricture.

Key words
ischemic biliary stricture, bilioenteric anastomosis, pancreaticoduodenctomy

Reprint requests
Shigenori Nagakura Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences 1-757 Asahimachi-dori, Niigata City, 951-8510 JAPAN

Accepted
June 25, 2002

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