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Percutaneous transhepatic balloon dilation for papillary stenosis
N Yuasa1, T Hattori, Y Kobayashi
1Department of Surgery, Japanese Red Cross Nagoya First Hospital, Japan.
Hepato-Gastroenterology
|November 1, 1995
Summary
This study reports a rare case of primary common bile duct stones caused by papillary stenosis. Successful treatment involved percutaneous transhepatic biliary drainage and balloon dilatation for this challenging biliary obstruction.
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Radiology
Background:
- Papillary stenosis is a rare cause of common bile duct stones.
- Previous surgeries (gastrectomy, cholecystectomy, choledocholithotomy) can complicate diagnosis and treatment.
- Elevated liver enzymes and biliary enzymes indicate biliary obstruction.
Observation:
- A 68-year-old male with a history of gastrectomy and cholecystectomy presented with epigastric pain and fever.
- Elevated liver enzymes and imaging revealed common bile duct dilatation with stones.
- Endoscopic retrograde cholangiopancreatography was unsuccessful; percutaneous transhepatic biliary drainage (PTBD) was performed.
Findings:
- Percutaneous transhepatic cholangioscopy facilitated lithotripsy.
- Percutaneous transhepatic manometry confirmed papillary stenosis.
- Balloon dilatation via the PTBD fistula successfully treated the condition.
Implications:
- This case highlights the diagnostic and therapeutic utility of percutaneous interventions for complex biliary stone disease.
- Effective management of papillary stenosis is crucial in preventing recurrent biliary obstruction.
- Percutaneous approaches offer a viable alternative when endoscopic retrograde cholangiopancreatography is not feasible.