Abstract
We report a case of traumatic choledochal stenosis successfully treated with percutaneous transhepatic biliary endoprosthesis. A 19-year-old man received a hard blow to his abdomen by an iron bar while catching a fly ball during a baseball game. Approximately ten days after the accident, he was admitted to our hospital because of anorexia and xanthochromic changes in his urine. On admission, impaired hepatic function and jaundice (T.Bil 13.3mg/dl) were observed. Abdominal CT showed dilatation from the intrahepatic bile duct to the superior bile duct and obstruction of common bile duct. Based upon his age and clinical course, the patient was diagnosed as having delayed traumatic choledochal stenosis. Percutaneous transhepatic cholangiodrainage (PTCD) was performed via a 7Fr. tube through the right intrahepatic bile duct. Subsequently, his jaundice improved, but the PTCD tube extubated itself spontaneously, following which another 7 Fr. PTCD tube was inserted through the left intrahepatic bile duct. Internal fistulization was achieved by an 8 Fr. PTCD tube, after 4 days resulting in complete internal fistulization by clamping the PTCD tube. The diameter of the stent tube was gradually increased to 14Fr.. After cholangiography confirmed adequate flow through the bile ducts, the stent tube was removed on the 74th hospital day. During the eight months that have elapsed since removal of the stent tube, the patient has been followed on an outpatient basis; no signs or symptoms of restenosis have been observed.
