Common bile duct necrosis after cardiac catheterization

Abstract

A case of necrosis of the entire extrahepatic biliary tract after cardiac catheterization is presented. The axial blood supply to these structures makes them susceptible to ischemic injury.

Ischemic cholangiopathy

“…Moreover, acute ischemic cholecystitis due to cholesterol crystal emboli has been well documented [170]. Cholesterol crystal embolism would be a likely explanation for a case of common bile duct necrosis occurring 4 days after cardiac catheterization [171].…”

Ischemic Cholangiopathy

“…64,65 Autopsy studies showed biliary involvement in 10 to 25% of patients, 66,67 and arterial occlusion by intimal fibrinoid necrosis, thrombosis, and granulation tissue have been found around damaged bile ducts. 68 In patients with atherosclerosis, atheromatous stenosis of the arterial branch has been suspected to be Hereditary hemorrhagic telangiectasia 57,58,110 Kawasaki disease 74 Radiotherapy on liver area 60,61 Schö nlein-Henoch purpura 75 Polyarteritis nodosa [66][67][68] Systemic lupus [76][77][78][79] Atherosclerosis and cholesterol-crystal embolism [69][70][71] Antiphospholipid syndrome 80 Paroxysmal nocturnal hemoglobinuria 81 Hypereosinophilic syndrome 82 Cholangiopathy occurring after septic shock 25,83 responsible for corresponding biliary strictures. 69,70 Furthermore, cholesterol crystal embolism would be a likely explanation for common bile duct necrosis occurring after cardiac catheterization in patients with atheroma.…”

“…69,70 Furthermore, cholesterol crystal embolism would be a likely explanation for common bile duct necrosis occurring after cardiac catheterization in patients with atheroma. 71 The second group of conditions associated with ischemic cholangiopathy comprises various diseases with biliary involvement in which microvascular injury is plausible, although not definitely proven. Postcholecystectomy biliary strictures can result from injury to the arterial supply of the common bile duct because gross and microscopic arterial supplies can be damaged by inadvertant sectioning, ligation, clipping, or thermal coagulation.…”