Korean J Gastroenterol.  2012 Dec;60(6):382-385. 10.4166/kjg.2012.60.6.382.

Biliary Cast Syndrome in Non-Liver Surgery Patients

• Ha SI
• Choi JS
• Kim YH
• Jun HS
• Jo YG
• Lee WH
• Park SG
• Lee SH

• KMID: 1773076
• DOI: http://doi.org/10.4166/kjg.2012.60.6.382

Abstract

Biliary cast describes the presence of casts within the biliary tree. It is resultant sequel of cholangitis and hepatocyte damage secondary to bile stasis and bile duct injury. Biliary cast syndrome was first reported in patient undergone liver transplantation. The pathogenesis of biliary cast is not clearly identified, but proposed etiologic factors include post-transplant bile duct damage, ischemia, biliary infection, or post-operative biliary drainage tube. Although biliary casts are uncommon, most of biliary cast syndrome are reported in the liver transplant or hepatic surgery patients. A few reports have been published about non-transplant or non-liver surgery biliary cast. We report two cases of biliary cast syndrome in non-liver surgery patients.

Keyword

Biliary cast; Liver transplantation; Ischemia

MeSH Terms

Acute Disease
Ascariasis/diagnosis
Bile Duct Diseases/*diagnosis/ultrasonography
Bile Ducts/ultrasonography
Cholagogues and Choleretics/therapeutic use
Cholangiopancreatography, Endoscopic Retrograde/adverse effects
Female
Gallstones/diagnosis
Humans
Liver Cirrhosis, Biliary/diagnosis/drug therapy
Male
Middle Aged
Pancreatitis/etiology
Tomography, X-Ray Computed
Ursodeoxycholic Acid/therapeutic use
Cholagogues and Choleretics
Ursodeoxycholic Acid

Figure

• 

  Fig. 1 Ultrasound finding. A hyperechoic double rim layer material was noted on the extrahepatic bile duct (arrow). It was initially thought as ascariasis.

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  Fig. 2 ERCP finding. A longitudinal tubular filling defect was shown on the common bile duct (arrow).

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  Fig. 3 Biliary cast. Dark brown colored cast material was removed endoscopically from the common bile duct.

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  Fig. 4 MRCP finding. A low signal intensity tubular filling defect was noted on the common bile duct (arrow).

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  Fig. 5 ERCP finding and biliary cast. (A) A number of longitudinal tubular filling defects was noted on the common bile duct (arrow). (B) Endoscopic appearance of biliary cast. (C) Multiple black colored cast materials was removed endoscopically from the common bile duct.

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