Oriental cholangiohepatitis

Case contributed by Dr Charudutt Jayant Sambhaji

Presentation

Jaundice.

Patient Data

Age: 32 years
Gender: Male
CT

Intrahepatic biliary tree dilatation, more in the left lobe than the right. The supraduodenal CBD showed wall thickening and smooth narrowing. Segment 8 of the liver showed relative shrinkage (atrophy) and multiple dense intraductal calculi. Low density calculi and sludge was also noted in the CBD. No gallbladder calculi were seen.

Fluoroscopy

ERCP

ERCP failed to negotiate the strictures.

Percutaneous transhepatic cholangiography (PTC)

Multiple intrahepatic tight strictures.

Case Discussion

Brush biopsy was negative for malignancy. By exclusion a diagnosis of oriental cholangiohepatitis was made. A right external  and a left internal external percutaneous biliary drainage was achieved with relief of symptoms. 

The best diagnostic clues are intra and extrahepatic biliary dilatation due to multilevel strictures and calculi within them without gallbladder calculi, combination of variable density calculi/sludge and regions of segmental liver atrophy secondary to chronic biliary obstruction.

Oriental cholangiohepatitis is a diagnosis made after exclusion of the common differential diagnosis for this condition, that include Intrahepatic stones secondary to biliary stricture of known cause like previous surgery, trauma, sclerosing cholangitis and cholangiocarcinoma.

The condition is usually associated with poor nutritional status and biliary parasitic infestation by Clonorchis sinensis and/or Ascaris lumbricoides and is primarily seen in SE Asians.

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Case information

rID: 5782
Case created: 22nd Mar 2009
Last edited: 21st Dec 2016
Inclusion in quiz mode: Included

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