OVERVIEW
Inflammatory bile duct stenosis is a narrowing of the bile duct caused by recurrent bile duct inflammation due to bile duct stones and infections of the bile duct, mucosal erosion, formation of ulcers, connective tissue proliferation, and scar formation. Stenosis can occur in any part of the bile duct, commonly at the opening of the left and right hepatic ducts, the upper end of the common hepatic duct and the lower end of the common bile duct. Clinical manifestations are similar to intrahepatic bile duct stones. Jaundice may occur in bilateral hepatic duct stenosis, and if not diagnosed and treated in time, biliary cirrhosis and portal hypertension may occur, and in severe cases, upper gastrointestinal hemorrhage and hepatic failure may be life-threatening.
Etiology
The disease is caused by repeated episodes of bile duct infection and scarring. The wall structure of the bile duct is damaged by long-term inflammation, and the elastic fiber layer is destroyed, and the surrounding collagen fibers proliferate, resulting in the narrowing of the wall, and thus the formation of bile duct stenosis.
Symptoms
1. When combined with extrahepatic bile duct stones, the symptoms of extrahepatic bile duct stones are predominant. When the stone is embedded and obstructs the bile duct and secondary infection occurs, abdominal pain, chills, high fever and jaundice may appear.
(1) Abdominal pain: mainly occurs in the subxiphoid process and right upper abdomen, mostly paroxysmal colic, accompanied by nausea, vomiting and other symptoms.
(2) Chills and high fever: when bile duct obstruction is secondary to bacterial infection, bacteria and toxins eventually enter the hepatic vein through capillary bile ducts and then enter the body circulation and cause systemic infection.
(3) Jaundice: the severity, occurrence and duration of jaundice depend on the degree of bile duct obstruction and whether it is complicated by infection.
2. When combined with intrahepatic bile duct stones, there are usually no obvious symptoms, or only distension and discomfort in the liver area and chest and back; when combined with infected obstruction at the same time, abdominal pain, chills and high fever will appear. Jaundice is not always present.
Examination
1. Ultrasound
The lumen of the bile ducts is obviously narrowed, mostly uniform. The wall of the bile ducts is obviously thickened, and the echogenicity of the intrahepatic bile ducts is enhanced.
2. Cholangiography
Cholangiography is characterized by: ① irregular multiple stenosis of the lesion site bile ducts, and smooth surface of the bile duct mucosa; ② stenosis lesions are limited or diffuse, or segmental changes; ③ mild dilatation of the proximal end of the stenotic bile ducts; ④ lesions involving the intrahepatic bile ducts, can be seen to reduce the branches of the intrahepatic bile ducts, stiffness and thinning of the withered twig like or bead-like, hemispherical dilatation; the gallbladder is involved in the thickening of the gallbladder wall.
3.CT examination
CT scan can show the dilatation and deformation of intrahepatic bile ducts; CT scan can better show the dilatation of bile ducts after stenosis, stones, hepatic lobe atrophy and displacement.
4.Liver biopsy
It shows concentric fibrosis of the peripheral bile ducts with or without hyperplasia of the bile ducts in the porta hepatis.
Diagnosis
Diagnosis can be made by CT examination, cholangiography and surgical exploration. When it is not easy to distinguish it from sclerosing cholangiocarcinoma, pathological section of the lesion can be taken for clear diagnosis.
Treatment
When there are extensive intrahepatic bile duct stones and changes in the liver parenchyma above the hepatic bile duct stenosis, the treatment is usually hepatic lobectomy. If the stenosis is located at the opening of the left and right hepatic ducts, the stenosis should be completely incised, and after removal of intrahepatic bile duct stones, hepatic cholangioplasty at the porta hepatis and hepatic cholangiojejunostomy in the form of a Y-shaped anastomosis should be performed. If the lesion is more complicated, a wide combined incision of the left and right hepatic ducts in the porta hepatis can be performed to remove the stones from the branches of the intrahepatic bile ducts, and then a wide-opening hepatic-jejunoileal anastomosis can be performed.