Obstructive Jaundice Due to Hilar Bile Duct Compression with Encasement of the Right Hepatic Artery

Ryusuke Ito, Yuji Ishii, Tadashi Uwagawa, Shigeki Wakiyama, Hiroaki Shiba, Takeyuki Misawa, Yuichi Ishida, Hiroshi Kakutani, Shunichi Sadaoka, Katsuhiko Yanaga

Abstract


A 68-year-old woman had a solitary 12.0 cm hepatic cyst with a septum. The cyst was located near the hepatic hilum and she presented with obstructive jaundice caused by compression of the hilar bile duct. Stenosis of the common hepatic duct was detected at the porta hepatis on endoscopic retrograde cholangiography (ERC), and encasement of the right hepatic artery at the same level was revealed by abdominal angiography. Transpapillary cholangioscopy showed compression and mucosal erosions of the hilar bile duct. After transpapillary cholangioscopy, the hepatic cyst became infected, for which emergency percutaneous transhepatic drainage was performed. As a result, the patients obstructive jaundice subsided. The mucosal erosions of the bile duct that existed at a site corresponding to the encasement of the right hepatic artery also improved. In conclusion, bile duct stenosis was considered to be caused by compression due to the hepatic cyst and the right hepatic artery.




doi:10.4021/gr2009.10.1319


Keywords


Obstructive jaundice; Right hepatic artery; Hepatic cyst; Hilar bile duct; Cholangioscopy

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