Biliary stricture with hepatolithiasis as a late complication of retrograde transhepatic biliary drainage

A 63-year-old man was admitted to a community hospital complaining of fever and epigastric pain. He had undergone cholecystectomy and choledocholithotomy with retrograde transhepatic biliary drainage 7 years previously. Referred to our hospital after demonstration of hepatolithiasis by computed tomography, he underwent further imaging that showed a dilated left lateral anterior segmental bile duct (B3) with hepatolithiasis. After he underwent percutaneous transhepatic biliary drainage via the B3 segmental bile duct, cholangiography performed through the drainage catheter revealed a biliary stricture at the confluence of B3 associated with intrahepatic stones. percutaneous transhepatic cholangioscopy showed a stricture and a cholangioscopic biopsy specimen contained no malignant cells. After performing cholangioscopic lithotomy, an endoprosthesis was inserted and connected to a subcutaneously placed reservoir. Repeat percutaneous transhepatic cholangioscopy 10 months later demonstrated a decreased degree of the stricture, so the endoprosthetic catheter could be removed. Retrospective review of computed tomography images obtained just after the first operation indicated that the retrograde transhepatic biliary drainage catheter had passed close to the B3, and that intrahepatic bile duct dilation was not present. Therefore, we suspect that biliary stricture was caused by an old bile duct injury due to retrograde transhepatic biliary drainage catheter placement. Percutaneous transhepatic cholangioscopy effectively managed this stricture and associated hepatolithiasis.