An unusual cause of biliary obstruction

Abstract

Portal biliary ductopathy (PBD) is a condition in which biliary and pancreatic ducts are extrinsically compressed by collateral branches of the portal venous system, which in turn have become dilated and varicosed due to portal hypertension. While the majority of patients with PBD are asymptomatic, a minority can present with symptoms of biliary obstruction and cholangitis with the potential of developing secondary chronic liver disease. This paper reports the case of a 29 year old male presenting with acute cholangitis, in whom PBD was diagnosed radiologically. A brief review of current literature regarding the diagnosis and management of this condition will also be presented.

Keywords: MRCP; biliary obstruction; biliary stenting Yeoh; cholangitis; portal hypertension.

Figure 1

An axial CT image demonstrating the common bile duct. Notes: Vertical arrow: diameter 3.9 mm, flanked by varicosed portal venous collaterals; Horizontal arrow: diameter 10.1 mm.

Figure 2

A coronal MRCP image demonstrating the dilated intrahepatic biliary tree. Notes: Vertical arrow: diameter of duct indicated 10 mm, with varicosed portal collaterals surrounding the common hepatic duct; Horizontal arrow: diameter 7.3 mm.

Figure 3

An MRCP image demonstrating extensive dilatation and structuring of the left intrahepatic biliary tree. Notes: Vertical arrow: diameter of duct indicated 15 mm, in preference to the right.

Figure 4

A fluoroscopy image taken during ERCP demonstrating smooth proximal bile duct compression. Notes: Horizontal arrow: diameter at area indicated 2.8 mm, and secondary distal bile duct dilatation; Vertical arrow: diameter at area indicated 15.4 mm.