Strictures of the intrahepatic bile ducts

Abstract

Strictures of the intrahepatic bile ducts are rare. Frequently, the condition passes unrecognized by both the internist and the surgeon, and is too often discovered only at autopsy. The strictures are related either to an inflammatory process, which is rare, or to a tumor which is more common. Benign or malignant stenosis may involve an intraparenchymatous hepatic duct or one of its segmental afferents. It results in proximal stasis, infection, lithiasis, and biliary cirrhosis. In fact, the prognosis and treatment of the lesion are dominated by the inflammatory or malignant origin of the stricture.

Focal intrahepatic strictures: a review of diagnosis and management

“…The first, representing 30% of patients, is asymptomatic where the lesion is identified incidentally 5 . The second, representing the remaining 60% to 70%, present with vague symptoms which predominantly include abdominal pain with occasional transient pyrexia and jaundice 3,5 . Abdominal pain occurring in almost half of these patients 5 is usually non‐specific and tends to precede other symptoms 3 .…”

“…The second, representing the remaining 60% to 70%, present with vague symptoms which predominantly include abdominal pain with occasional transient pyrexia and jaundice 3,5 . Abdominal pain occurring in almost half of these patients 5 is usually non‐specific and tends to precede other symptoms 3 . It is hypothesized that the pain is as a result of episodes of cholangitis.…”

“…Abnormalities of liver function tests (LFTs) in FIHS tend to be milder compared with those that cause more distal obstruction 5 . alkaline phosphatase (ALP) and gamma glutamyltransferase levels are elevated in the majority (65%) of patients, whereas bilirubin levels are rarely abnormal 3,5 . Although statistically significant differences between levels of ALP have been associated with malignant vs. benign strictures (>200 U/l, P = 0.036 4 ), their ability to distinguish the two groups is limited by poor sensitivity and specificity.…”

“…Biliary strictures most commonly involve the extrahepatic biliary tree 1 and usually present with clinical and biochemical evidence of biliary obstruction 2 . Focal intrahepatic strictures (FIHS) involve the segmental intrahepatic ducts, are much rarer and are often asymptomatic 3 . They are often detected as incidental findings after imaging performed for other reasons 4 .…”

Are Modified Procedures Significantly Better than Conventional Procedures in Percutaneous Transhepatic Treatment for Complicated Right Hepatolithiasis with Intrahepatic Biliary Strictures?

“…The most dif cult aspect of treatment is dealing with coexisting intrahepatic biliary stricture, which may limit stone eradication and lead to a propensity for stone recurrence (4)(5)(6)(7)(8). The presence of biliary stricture and either residual or recurrent stones may result in a vicious cycle, with recurrent hepatolithiasis and other untoward sequelae (4,5,(9)(10)(11). Hepatic resection is usually preferred to eradicate localized hepatolithiasis with strictures in the left lobe of the liver because of low surgical mortality and morbidity (7,8).…”