A CASE OF LOCALIZED PRIMARY SCLEROSING CHOLANGITIS IN WHICH AN EXCISION OF THE LESION PROVIDED AN UNEVENTFUL POSTOPERATIVE COURSE

Abstract

We experienced a relatively rare case of localized primary sclerosing cholangitis (PSC) of extrahepatic bile dut type in which an excision of the lesion successfully provided a recurrence free 6-year postoperative period.
A 69-year-old man was admitted to the hospital because of nausea and upper abdominal pain. On imaging methods, a dilatation of the intrahepatic bile duct and a tumor shadow at the confluence of the right and left hepatic ducts were revealed. Choledochography disclosed a stricture of the bile duct at the porta hepatis. With a diagnosis of hilar bile duct cancer, an excision of the bile duct at the porta hepatis and associated resection of the right hepatic artery were conducted. Histopathological examination, however, showed only inflammatory lesion with fibrous change and no tumor findings were seen. The definite diagnosis of PSC was made.
Diffused type of PSC is most common in those patients with PSC and medical treatments are generally employed for them. As to localized type of PSC, we often have difficulty in differential diagnosis from bile duct cancer and those patients experience recurrence after excision of the lesion in a low frequency. Accordingly we think that aggressive surgical resection would be a reasonable therapy.