A control upper abdominal ultrasound confirmed dilatation of intra and extrahepatic biliary ducts
, while a small amount of suspected intraluminal bile content was detected in the gallbladder.
Non-surgical methods (such as PTC, ERCP) were primarily used for therapeutic purposes in minor type injuries in which main biliary duct
continuity is mostly protected.
The incidence of rupture into the biliary tree ranges between 3 and 17%.7-9 The rupture of the hydatid cyst in the biliary ducts
and the migration of the hydatid material in the biliary tree lead to the apparition of other biliary complications like: cholangitis, sclerosis odditis, hydatid biliary lithiasis etc.6 In our case involvement of biliary tree and common bile duct was seen leading to cholangitis and jaundice.
The presence of gallbladder filling defects does not necessary mean that the gallbladder is the source of bleeding, as blood can enter the gallbladder retrograde from the biliary ducts
. If endoscopic ultrasound (EUS) is available, it may be used as an adjunctive noninvasive method to evaluate vascular aneurysms and blood clots within the biliary ducts
when eRcP findings are equivocal [36-38].
Magnetic resonance cholangiopancreatography (MRCP) (Figure 2) was subsequently performed which confirmed the above findings and no biliary duct
stones were identified.
Caption: Figure 5: Endoscopic retrograde cholangiography showing presence of stricture in the biliary duct
pre-ERC (a) compared to post-ERC (b).
In typical biliary duct
course, the lateral hepatic bile duct supplying segments VI and VII and the paramedian hepatic bile duct supplying segments V and VIII reunite to form the right hepatic bile duct (RHD).
Carbohydrate antigen 19-9 (CA19-9) is a mucinic glycoprotein that is expressed on pancreatic and biliary duct
Magnetic resonance cholangiopancreatography and cholangiogram revealed biliary obstruction, with intrahepatic biliary duct
dilatation, due to the presence of biliary stones in the main bile duct and near the biliary-enteric anastomosis (Figure 1).
Cholangiocarcinoma is an adenocarcinoma which arises from biliary duct
epithelium often in the setting of pre-existing biliary tract disease such as PSC.
The disease is a part of small biliary duct
diseases and the major diseases affecting these ducts as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are to be ruled out before labeling IAD .