Biliary stricture

Alternative names

Bile duct stricture

Definition

Biliary stricture involves an abnormal narrowing of the biliary duct that transports bile (a chemical used in digestion) from the liver to the small intestine.

Causes, incidence, and risk factors

Biliary strictures are often caused by surgical trauma to the bile ducts, for example, after surgery to remove the gallbladder (cholecystectomy).

Other causes of this condition are blunt injury to the intestine, pancreatitis, breakdown of the duct by a gallstone in the bile duct, primary sclerosing cholangitis, and cancer of the bile duct.

Risk factors include previous biliary surgery, pancreatitis, cholelithiasis, or injury to the intestine.

Symptoms

• Abdominal pain
  
• Fever
  
• Chills
  
• Jaundice
  
• Pale or clay-colored stools
  
• Nausea and vomiting
  
• Itching
  

Signs and tests

Tests that show stricture in the bile duct:

• ERCP (endoscopic retrograde cholangiopancreatography)
  
• PTC (percutaneous transhepatic cholangiogram)
  
• MRCP (magnetic resonance cholangiopancreatography)
  

Blood tests that indicate abnormal function of biliary system:

• Bilirubin level is elevated
  
• ALP (alkaline phosphatase) is elevated
  

This disease may also alter the results of the following tests:

• Fecal fat
  
• Urine bilirubin
  
• Prothrombin time (PT)
  
• Amylase
  
• Lipase
  

Treatment

Either endoscopic (a tube called an endoscope is passed through a small incision) or percutaneous (through the skin) dilation of the stricture may be used, depending on the location of the stricture.

The objective of surgical therapy is to re-establish the flow of bile from the liver into the intestine. Depending on the location, the stricture may be surgically removed and the biliary duct rejoined with the small intestine or the hepatic duct.