2004 Volume 37 Issue 12 Pages 1851-1856
A 63-year-old man who underwent pylorus-preserving pancreaticoduodenectomy for carcinoma of the duode-nal papilla 4 years 3 months earlier, was admitted for fever and abdominal pain. Computed tomography showed dilation of the intrahepatic bile duct but no tumor. Percutaneous transhepatic cholangiography (PTC) showed obstruction at the common hepatic duct, necessitating PTC drainage. Percutaneous transhepatic cho-langioendoscopy (PTCS) showed no malignant signs around the obstruction. An attempt to pass a wire through the obstruction failed. We made a diagnosis of benign biliary obstruction with resultant hepaticojeju-nal anastomosis. At laparotomy, the hepaticojejunal anastomosis was very narrow. We resected the thickened hepatic duct followed by bilioenteric reanastomosis. Histologically, the resected specimen showed dense fibrous tissue with chronic inflammatory infiltrates compatible with ischemic biliary obstruction. The postop-erative course was uneventful and the patient is doing well.
