Biliary stricture

Definition

A biliary stricture is an abnormal narrowing of the common bile duct, the tube that moves bile (a substance that helps with digestion) from the liver to the small intestine.

Alternative Names

Bile duct stricture

Causes

A biliary stricture is often caused by surgical injury to the bile ducts. For example, it may occur after surgery to remove the gallbladder.

Other causes of this condition include:

• Cancer of the bile duct
• Damage and scarring due to a gallstone in the bile duct
• Pancreatitis
• Primary sclerosing cholangitis

Risk factors include previous biliary surgery, pancreatitis, gallstones, or injury to the intestine.

Symptoms

• Abdominal pain on the upper right side of belly
• Chills
• Fever
• Itching
• Jaundice
• Nausea and vomiting
• Pale or clay-colored stools

Exams and Tests

The following tests can help diagnose this condition:

• Endoscopic retrograde cholangiopancreatography (ERCP)
• Percutaneous transhepatic cholangiogram (PTC)
• Magnetic resonance cholangiopancreatography (MRCP)

The following blood tests can help reveal a problem with the biliary system.

• Alkaline phosphatase (ALP) is higher than normal.
• Bilirubin level is higher than normal.

This condition may also alter the results of the following tests:

• Amylase level
• Lipase level
• Urine bilirubin
• Prothrombin time (PT)

Treatment

The goal of treatment is to correct the narrowing so bile flow normally from the liver into the intestine.

This may involve:

• Surgery
• Endoscopic or percutaneous dilation

If surgery is done, the stricture may be removed and the common bile duct rejoined with the small intestine.

In some cases, a stent (a tiny metal or plastic mesh tube) is placed across the bile duct stricture to keep it open. See: Stent

Outlook (Prognosis)

Treatment is usually successful.

Possible Complications

Inflammation and narrowing of the biliary duct may return in some people. There is a risk for infection above the narrowed area. Long-standing strictures can lead to cirrhosis.

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms recur after pancreatitis, cholecystectomy, or other biliary surgery.

References

Afdhal NH. Diseases of the gallbladder and bile ducts. In:Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: SaundersElsevier; 2011:chap 158.

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