A Case of Hepatic Peribiliary Cysts with Hepatic Hilar Bile Duct Stenosis due to Enlargement after Total Gastrectomy

Abstract

The patient was a 75-year-old man, who presented with a history of recurrent fever and bacteremia three months after he underwent laparoscopic total gastrectomy for gastric cancer. Twelve months after the onset of symptoms, jaundice developed and close examination revealed that the hepatic peribiliary cysts (HPBCs) which had been detected at the time of gastric cancer surgery, had increased in size, one of the enlarged cysts causing narrowing of the origin of the left hepatic duct. A tube stent was placed in the bile duct, and puncture of the enlarged cyst that appeared to be the cause of the stenosis was performed; however, the cholangitis was difficult to control. Therefore, eventually, left hepatectomy was performed. There has been no evidence of recurrence of cholangitis after the operation.

HPBCs are usually followed up if asymptomatic, but treatment becomes necessary if they cause jaundice or cholangitis. Our present case was a rare case that required surgical treatment, because enlargement of the cysts after total gastrectomy caused hilar bile duct stenosis. Therefore, we report this case with a brief review of the literature.