Biliary stricture

Introduction

-A bile duct stricture is an abnormal narrowing of the common bile duct. 

-Most benign strictures of the extrahepatic bile ducts result from surgical trauma (95% of cases) 

-Causes: injury to the bile ducts, cancer of the bile duct, liver or pancreas, pancreatitis, primary sclerosing cholangitis 

Symptoms & Signs

RUQ abdominal pain, fever, chills, itching, jaundice, pale or clay-colored stools 

Diagnosis 

Labs: bilirubin level is higher than normal, elevated serum alkaline phosphatase 

Imaging: Ultrasound, CT, ERCP, MRCP, Percutaneous cholangiography  

Treatment 

-The goal of treatment is to correct the narrowing. This will allow bile to flow from the liver into the intestine.

-Fluid resuscitation, antibiotic coverage 

-ERCP, MRCP, Sphincterotomy to allow closure of a bile leak, dilation of the stricture and stent placement

-Surgery in select cases 

Prognosis 

Long-term success depends on the cause of the stricture. Good prognosis with benign causes and bad prognosis with malignant causes. 

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