BILE DUCT STRICTURES
What is a bile duct stricture?
A bile duct stricture is caused by narrowing of the bile duct. The narrow bile duct prevents the bile from draining into the intestine. The bile then backs up in the liver and spills over into the blood causing obstructive jaundice?
What are the causes of bile duct stricture?
There are many causes for biliary stricture. These causes can be benign (non-cancerous) or cancerous. Cancerous bile duct strictures are caused by bile duct cancer and pancreatic cancer. Benign (non-cancerous) bile duct strictures may develop from chronic pancreatitis, injury to the bile duct after a laparoscopic cholecystectomy and a variety of infective causes that are uncommon in the United States.
The most common cause for a benign bile duct stricture is trauma to the bile duct during a laparoscopic cholecystectomy for gallstone disease. It is estimated that approximately 0.1% to 1% of gallbladder operations may lead to injury to the bile duct with subsequent development of a bile duct stricture. In addition to injury to the bile duct, injury to the hepatic artery (the blood vessel that supplies blood to the liver) is commonly associated with a bile duct injury.
How does bile duct injury from laparoscopic cholecystectomy develop?
Patients with bile duct injury after a laparoscopic cholecystectomy can present with the injury soon after the cholecystectomy or many weeks to months after the injury.
Patients who present early usually present with leakage of bile into the abdominal cavity. Some of the symptoms that are associated with this include persistent pain and discomfort and feeling of illness after the laparoscopic cholecystectomy. Patients recover rapidly after laparoscopic cholecystectomy and the majority of patients are back to their pre-surgery state within ten days to two weeks. Patients who continue to complain of symptoms and are not improving should be evaluated for possible bile duct injury from laparoscopic cholecystectomy. Often patients will develop fevers and jaundice.
Patients who develop delayed symtoms from a bile duct stricture usually have scarring of the bile duct from the injury. These patients typically present with dilatation of their bile duct above the point of injury. At the point of injury the scarring gives rise to narrowing so that bile cannot go through. The bile then spills over into their blood and they typically present with jaundice.
Treatment of bile duct injuries
Early detection of bile duct injuries is important and with appropriate treatment patients generally do well. The principles of treatment of bile duct injury include:
Treatment of bile duct injury in a specialized center
Patients with bile duct injury often require complex operations that may range from a simple repair for a low bile duct injury to a complex repair to small ducts with possible need for removal of part of their liver tissue for injuries high up in the bile duct close to the liver.
For best results these patients are best treated in a specialized center that has experience in treating bile duct injuries for optimal outcome. The USC Center for Pancreatic and Biliary diseases is a specialized referral center for treatment of complex bile duct injuries.
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