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.