A Case of Chronic Cholangitis with Ulcer of the Common Bile Duct Difficult to Differentiate from Bile Duct Cancer

Yoshiharu Shirakata, Naoya Sasaki, Hisashi Shinohara, Kazumi Itoi, Manabu Fukuyama, Hidefumi Nishikawa, Yoshifumi Mizuno and Rokuro Mimura*

Department of Surgery and Department of Pathology*, Hyogo Prefectural Amagasaki Hospital

An 80-year-old woman with right hypochondralgia consulted a local practitioner and an elevation in hepatobiliary enzymes, a swelling of the gallbladder, and a dilatation of the biliary tract were noted. She was referred to our hospital for further examination. Abdominal enhanced computed tomography (CT) showed a swelling of the gallbladder and dilatation of the intra and extra hepatic biliary tract, but did not show any obvious tumor image. MRCP showed a swelling of the gallbladder, a dilatation of the upper biliary tract, and a V-shaped stenosis of the lower biliary tract. Direct cholangiography through a percutaneous transluminal gallbladder drainage (PTGBD) tube showed the obstruction of the lower biliary tract. An operation was performed because the possibility of malignancy could not be ruled out. We noticed an elastic hard tumor measuring 3.0 cm in diameter in the middle and lower biliary tract with severe adhesion to the portal vein and marked swelling of the lymph nodes around the biliary tract. We could not detach the tumor from the portal vein, so a pancreatoduodenectomy with a concomitant wedge resection of the portal vein was performed. The histological diagnosis was an ulcer of the bile duct caused by chronic cholangitis, and no evidence of malignancy was seen. The patient's postoperative course was good. This case is extremely rare because, to our knowledge, a benign ulcer of the bile duct with chronic cholangitis has never before been reported in the literature.

Key words
chronic cholangitis, ulcer of the bile duct, bile duct cancer

Reprint requests
Yoshiharu Shirakata Department of Surgery, Hyogo Prefectural Amagasaki Hospital
1-1-1 Higashidaimotsu-cho, Amagasaki, 660-0828 JAPAN

Accepted
November 28, 2007

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