The Diagnostic Dilemma of Malignant Biliary Strictures.
Biliary stricture, also known as bile duct stricture, occurs when the bile duct gets smaller or narrower. The bile duct is the tube that takes bile from the liver to the small bowel. Bile is a substance that helps in digestion of fatty food and excreting (getting rid of) harmful substances.
Bile duct stricture A bile duct stricture is an abnormal narrowing of the common bile duct. This is a tube that moves bile from the liver to the small intestine. Bile is a substance that helps with digestion.
PURPOSE: To evaluate retrospectively the use of multiphasic helical computed tomography (CT) to differentiate malignant and benign common bile duct (CBD) strictures in patients with only a focal CBD stricture and to determine predictors for this differentiation. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were not required.
One major category of bile duct strictures is postoperative bile duct stricture, which usually occurs as a result of a technical mishap during cholecystectomy, causing bile duct injury. Data from many large series of patients in the US have revealed that the incidence rate of major bile duct injury is 0.2-0.3% after open cholecystectomy and 0.4-0.6% after a laparoscopic cholecystectomy.
Malignant bile duct strictures may be secondary to primary bile duct carcinomas such as cholangiocarcinoma, or to extrinsic compression and invasion by malignancies of the adjacent organs such as the gallbladder, liver, and pancreas (3). Extrinsic compression or invasion by porta hepatis lymph nodes and invasion by bile duct metastases may on occasion cause malignant strictures.
Uncommonly (in 1% of cholecystectomies), a large gallstone becomes impacted in the cystic duct or the neck of the gallbladder, compresses the common bile duct, and causes obstruction and jaundice (Mirizzi syndrome). If gallstones pass into the bile ducts causing obstruction, the result can be biliary pain and, importantly, cholangitis.
Common bile duct stricture is a common complication following open cholecystectomy. Approximately 80% of benign strictures occur following injury during a cholecystectomy.