Clin Endosc.  2013 Jan;46(1):98-101. 10.5946/ce.2013.46.1.98.

A Case of Biliary Cast Developed in a Patient with Long-Standing Biliary Sludge

• Koo JW
• Jang NE
• Lee HJ
• Joo KR
• Cha JM
• Shin HP
• Lee JI
• Lim SJ

• KMID: 1792649
• DOI: http://doi.org/10.5946/ce.2013.46.1.98

Abstract

Development of biliary casts is very unusual, especially in patients who have not undergone liver transplantation. Variable causes of biliary cast formation in nonliver transplantation patients have been suggested. However, stasis of bile flow and/or gallbladder hypocontractility is known to eventually result in the promotion of biliary sludge and subsequent cast formation. Here we present one case of biliary cast syndrome, which developed in a nonliver transplant patient who had biliary sludge for a long period of time, providing evidence that long-standing biliary sludge may lead to cast formation.

Keyword

Cast; Biliary tract; Sludge; Gallbladder; Nontransplant

MeSH Terms

Bile
Biliary Tract
Gallbladder
Humans
Liver Transplantation
Sewage
Superior Mesenteric Artery Syndrome
Transplants
Sewage

Figure

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  Fig. 1 Cholangiographic finding obtained by percutaneous cholecystostomy. Multiple filling defects (arrows) are noted in the extrahepatic bile duct.

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  Fig. 2 Duodenoscopic finding during endoscopic retrograde cholangiopancreatography. Black-colored tubular structures were extracted from the bile duct with a retrieval basket.

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  Fig. 3 Pathologic finding of the tubular structures. It shows aggregated bile pigmented amorphous materials, consistent with biliary cast (papanicolaou stain, ×100).

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  Fig. 4 Ultrasonographic finding, performed 1 year before admission. Gallbladder was distended and filled with a large amount of sludge.

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  Fig. 5 Pattern of the patient's liver biochemistry during the past year, before admission for acute cholangitis. Dotted lines indicate the upper limit of the normal range of each value. AST, aspartate aminotransferase; ALT, alanine aminotransferase.

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