A Case of Benign Biliary Obstruction Following Pylorus Preserving Pancreaticoduodenectomy

Tetsuya Kondo, Yasuhiro Sumi, Katsutoshi Murase, Tsuyoshi Shimamoto, Takuya Sugimoto, Goro Tajima and Yutaka Ozeki

Department of Surgery, Tosei National Hospital

A 63-year-old man who underwent pylorus-preserving pancreaticoduodenectomy for carcinoma of the duodenal papilla 4 years 3 months earlier, was admitted for fever and abdominal pain. Computed tomography showed dilation of the intrahepatic bile duct but no tumor. Percutaneous transhepatic cholangiography (PTC) showed obstruction at the common hepatic duct, necessitating PTC drainage. Percutaneous transhepatic cholangioendoscopy (PTCS) showed no malignant signs around the obstruction. An attempt to pass a wire through the obstruction failed. We made a diagnosis of benign biliary obstruction with resultant hepaticojejunal anastomosis. At laparotomy, the hepaticojejunal anastomosis was very narrow. We resected the thickened hepatic duct followed by bilioenteric reanastomosis. Histologically, the resected specimen showed dense fibrous tissue with chronic inflammatory infiltrates compatible with ischemic biliary obstruction. The postoperative course was uneventful and the patient is doing well.

Key words
biliary obstruction, pancreaticoduodenectomy, hepaticojejunal anastomosis

Reprint requests
Tetsuya Kondo Department of Surgery, Tosei National Hospital
762-1 Shimizucho, Suutogun, Shizuoka, 411-8611 JAPAN

Accepted
May 25, 2004

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