J Yeungnam Med Sci.  2022 Apr;39(2):161-167. 10.12701/yujm.2021.01179.

Congenital web of the common bile duct combined with multiple intrahepatic duct stricture: a case report of successful radiological intervention

• Lim H
• Hwang S
• Ko GY
• Han H

• KMID: 2529275
• DOI: http://doi.org/10.12701/yujm.2021.01179

Abstract

Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. We herein report a case of common bile duct septum combined with multiple intrahepatic bile duct strictures in a 74‐year‐old female patient who was successfully treated with radiological intervention. The patient initially visited the hospital because of upper abdominal pain. Imaging studies revealed multifocal strictures with dilatation in both intra- and extrahepatic ducts; the final clinical diagnosis was congenital common bile duct web combined with multiple intrahepatic duct strictures. Surgical treatment was not indicated because multiple biliary strictures were untreatable, and the disease was clinically diagnosed as benign. The multiple strictures were extensively dilated twice through bilateral percutaneous transhepatic biliary drainage (PTBD) for 2 months. After 1 month of observation, PTBD catheters were successfully removed. The patient is doing well at 6 months after completion of the radiological intervention, with the maintenance of normal liver function. Congenital web of the bile duct is very rare, and its treatment may vary depending on the patterns of biliary stenosis. In cases where surgical intervention is not indicated for congenital web and its associated disease, radiological intervention with balloon dilatation can be a viable therapeutic option.

Keyword

Bile duct obstruction; Congenital anomaly; External drainage; Interventional radiology; Obstructive jaundice

Figure

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  Fig. 1. Initial imaging studies. (A, B) Abdominal computed tomography shows diffuse dilatation of the intra- and extrahepatic bile ducts. (C, D) Magnetic resonance cholangiopancreatography shows multifocal biliary webs without anomalous pancreaticobiliary junction. Arrow indicates the location of a common bile duct web.

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  Fig. 2. The second magnetic resonance cholangiopancreatography shows multifocal stricture with dilatation in both intra- and extrahepatic ducts, suggesting that the stricture is more likely to be benign than malignant. The (A) location and (B) degree of the multifocal strictures are visualized.

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  Fig. 3. Direct cholangiography findings. (A) The left-sided tubogram shows complete occlusion of the left hepatic duct. (B) The right-sided tubogram shows bile duct occlusion at the hepatic hilum. (C, D) The common bile duct web is finally cannulated after repeated trials, and then balloon dilatation of the intra- and extrahepatic stricture is performed.

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  Fig. 4. The second balloon dilatation of the biliary stricture. (A) Tubogram shows the presence of residual strictures. (B, C) The second balloon dilatation of the intra- and extrahepatic stricture is extensively performed. (D) Tubogram shows improvement in multiple strictures.

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  Fig. 5. Follow-up tubogram showing the good passage of the bile duct.

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  Fig. 6. Follow-up hepatobiliary scintigraphy taken at 6 months after the treatment showing a 90-minute excretion rate of 80% without significant obstruction. ANT, anterior view.

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  Fig. 7. Follow-up computed tomography taken at 6 months after the treatment showing a thin doughnut-shaped web at the distal bile duct. Dotted arrows indicate the proximal and distal levels of the bile duct to the web. Solid arrow indicates the level of a web at the distal bile duct.

Reference

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