Biliary Stricture

Focal narrowing or structuring in the biliary ducts may be secondary to neoplasia, inflammation, trauma (iatrogenic or noniatrogenic), or mass effect from adjacent processes [13, 14]. The location of biliary strictures narrows the differential diagnosis. Strictures at the level of the porta hepatis (in or near the confluence of the right and left hepatic ducts) may be secondary to hilar cholangiocarcino-ma (Klatskin tumor) (Fig. 4), inflammation, or vascular impressions. Strictures in the mid portion of the extra-hepatic bile duct are commonly related to diseases of the gallbladder, such as carcinoma that has invaded the cystic duct and hepatoduodenal ligament, or inflammatory conditions, such as impaction of a stone in the cystic duct (Mirrizi syndrome). Distal extrahepatic strictures may be due to inflammatory or neoplastic diseases of the pancreas, primary carcinomas of the bile duct or ampulla, sphincter of Oddi dysfunction, or less commonly, infectious papillitis that may be seen in AIDS cholangiopathy.

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