STRICTURES
TYPE CRITERIA
Low common hepatic duct stricture with a length of common hepatic duct stump of
1 > 2 cm
Proximal common hepatic duct stricture with hepatic duct stump < 2 cm
2
Hilar stricture, no residual common hepatic duct, but the hepatic ductal confluence
3 is preserved
TYPE CRITERIA
A Cystic duct leak or leak from small ducts in the
liver bed
B Occlusion of an aberrant right hepatic duct
Biliary fistula
Clinical Presentation
Biliary colic
Obstructive Jaundice
Features of ascending cholangitis
- Charcot’s triad, Reynold’s pentad
Past history of cholecystectomy.
History suggestive of pancreatitis , trauma ,
radiation , alcohol abuse.
Overall only 10% of post-op. bile duct strictures are
recognized within 1st week and approx. 70% are
diagnosed within 6 months of original operation.
Laboratory Tests
Liver function tests usually show evidence of cholestasis
with fluctuating serum bilirubin level.
Information about PV
level of stenosis
Contrast enhanced CT abdomen
CT helps in assessing any intra abdominal
collection.
Definite level of bile duct stricture, dilated
intrahepatic radicals with cholangitic abscess.
Vascular injury with liver atrophy-hypertrophy
complex.
Limited in evaluation of the type and extent of
biliary stricture.
Magnetic Resonance
Cholangiopancreatography
Non-invasive method
Only diagnostic
Provides anatomic
information about
location and degree of
dilatation CBD
Delineate the
intrahepatic and PD
Useful in intrahepatic
biliary disease
Dahl noted Roux en-Y HJ for surgical treatment of bile duct injury in 1909. In1969,
Smith created a mucosal graft anastomosis in the repair of the damaged proximal
bile duct.
In 1954, Hepp and Couinaud described the hilar plate and long extrahepatic
course of the left hepatic duct.
Choledochojejunostomy
Concerns :
bile reflux
ascending cholangitis
sump syndrome
Choledochojejunostomy
Roux-en-Y Hepaticojejunostomy (ideal)
It is the preferred method of surgical biliary
drainage in most instances, and is the standard
method of biliary reconstruction following bile
duct resection.