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Obstructive jaundice and cholangitis caused by an arterial ring of the proper hepatic artery around the common bile duct.

Bilanovic D, Zdravkovic D, Toskovic B, Randjelovic T, Dikic S, Djukanovic B, Zdravkovic M - Med. Sci. Monit. (2011)

Bottom Line: Multislice CT angiography showed that the arterial ring of the common hepatic artery around the common bile duct (CBD) originated from the superior mesenteric artery.In such cases dissection of the proper hepatic artery from the common hepatic duct is the treatment of choice.CT angiography may be helpful in identifying these malformations.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

ABSTRACT

Background: Many different benign and malignant diseases can cause obstruction of the extrahepatic biliary duct. One of the more serious complications of biliary obstruction is cholangitis leading to emergency decompression. Anatomic variations are frequent in this region; however, it has rarely been reported that the extrahepatic bile duct is compressed by the arterial vessels.

Case report: We present the case of a 68-year-old woman who was admitted through the emergency department of our hospital with jaundice, abdominal pain and fever. Biochemical analyses of liver function showed increased value of AST (113 IU/L) and AST (128 IU/L). Total bilirubin was 5.88 mg/dl, conjugated bilirubin was 3.00 mg/dl, and alkaline phosphatase was 393 IU/L. We performed abdominal ultrasound (US), magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) imaging. Multislice CT angiography showed that the arterial ring of the common hepatic artery around the common bile duct (CBD) originated from the superior mesenteric artery. Cholecystectomy and intraoperative cholangiography were performed, as well as decompression and lavage of the biliary tree. Escherichia coli was identified from bile. Dissection of the hepatoduodenal ligament confirmed that the proper hepatic artery made a vascular ring around the CBD. Finally, a T tube was placed into the CBD. During 5 years of follow-up the patient has been without recurrent episodes of jaundice. In such cases dissection of the proper hepatic artery from the common hepatic duct is the treatment of choice.

Conclusions: If there are signs of cholangitis decompression and lavage of the biliary tree with "T", drainage should be performed. Vascular malformations should be considered as a possible cause of extrahepatic biliary obstruction. CT angiography may be helpful in identifying these malformations.

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CT angiography of the abdominal aorta and its braches – arterial ring of the proper hepatic artery is clearly visible.
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f1-medscimonit-17-8-cs91: CT angiography of the abdominal aorta and its braches – arterial ring of the proper hepatic artery is clearly visible.

Mentions: An abdominal ultrasonography and a magnetic resonance cholangiopancreatography (MRCP) revealed a distended gallbladder and dilation of the intrahepatic and extrahepatic bile ducts with unknown cause of the obstruction. For further evaluation we performed multi-slice computed tomography (MDCT) imaging, which showed an arterial ring formed by the common hepatic artery which originated from the superior mesenteric artery (Figure 1).


Obstructive jaundice and cholangitis caused by an arterial ring of the proper hepatic artery around the common bile duct.

Bilanovic D, Zdravkovic D, Toskovic B, Randjelovic T, Dikic S, Djukanovic B, Zdravkovic M - Med. Sci. Monit. (2011)

CT angiography of the abdominal aorta and its braches – arterial ring of the proper hepatic artery is clearly visible.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539617&req=5

f1-medscimonit-17-8-cs91: CT angiography of the abdominal aorta and its braches – arterial ring of the proper hepatic artery is clearly visible.
Mentions: An abdominal ultrasonography and a magnetic resonance cholangiopancreatography (MRCP) revealed a distended gallbladder and dilation of the intrahepatic and extrahepatic bile ducts with unknown cause of the obstruction. For further evaluation we performed multi-slice computed tomography (MDCT) imaging, which showed an arterial ring formed by the common hepatic artery which originated from the superior mesenteric artery (Figure 1).

Bottom Line: Multislice CT angiography showed that the arterial ring of the common hepatic artery around the common bile duct (CBD) originated from the superior mesenteric artery.In such cases dissection of the proper hepatic artery from the common hepatic duct is the treatment of choice.CT angiography may be helpful in identifying these malformations.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

ABSTRACT

Background: Many different benign and malignant diseases can cause obstruction of the extrahepatic biliary duct. One of the more serious complications of biliary obstruction is cholangitis leading to emergency decompression. Anatomic variations are frequent in this region; however, it has rarely been reported that the extrahepatic bile duct is compressed by the arterial vessels.

Case report: We present the case of a 68-year-old woman who was admitted through the emergency department of our hospital with jaundice, abdominal pain and fever. Biochemical analyses of liver function showed increased value of AST (113 IU/L) and AST (128 IU/L). Total bilirubin was 5.88 mg/dl, conjugated bilirubin was 3.00 mg/dl, and alkaline phosphatase was 393 IU/L. We performed abdominal ultrasound (US), magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) imaging. Multislice CT angiography showed that the arterial ring of the common hepatic artery around the common bile duct (CBD) originated from the superior mesenteric artery. Cholecystectomy and intraoperative cholangiography were performed, as well as decompression and lavage of the biliary tree. Escherichia coli was identified from bile. Dissection of the hepatoduodenal ligament confirmed that the proper hepatic artery made a vascular ring around the CBD. Finally, a T tube was placed into the CBD. During 5 years of follow-up the patient has been without recurrent episodes of jaundice. In such cases dissection of the proper hepatic artery from the common hepatic duct is the treatment of choice.

Conclusions: If there are signs of cholangitis decompression and lavage of the biliary tree with "T", drainage should be performed. Vascular malformations should be considered as a possible cause of extrahepatic biliary obstruction. CT angiography may be helpful in identifying these malformations.

Show MeSH
Related in: MedlinePlus