Abstract
Sixteen cases of primary biliary cirrhosis (PBC) were chronologically investigated by peritoneoscopy. An analysis of the liver surface appearence was made including the dye contrast method. The implications for clinical manifestations were studied based on these findings. Ordinary alterations of the liver surface appearence according to the progress of PBC started with gentle undulations (formation of roughly bounded areas from one to three cm in diameter by dye contrast method) and progressed to subtle irregularities (minute bounded areas from 0.3 to 0.5 cm in diameter by dye contrast method) and finally supposed to progress to biliary cirrhosis. Out of these, the gentle undulations and roughly bounded areas are thought to have diagnostic significance for the liver surface appearence of PBC in a relatively early stage. With the dye contrast method, the concaved areas of the gentle undulations were the locations in which altered portal areas were more densely distributed and, on the contrary, the convexed areas contained less altered portal area. The formation of roughly bounded areas was considered to manifest the status of rather advanced fibrosis of these concaved portions. As for the findings of atypical liver surface of PBC, the following cases were observed : reddish markings which indicates portal and periportal inflammation with an irregular liver surface as in chronic active hepatitis, smooth liver surface which is observed from onset in extensive cholestasis over a thirteen years of prolonged period, and other hepatic impairment as is observed with chronic alcoholic hepatic impairment. In these cases, the diagnosis of PBC was often difficult when based only on the peritoneoscopic findings.
