Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Biliary Cast Syndrome in a Non-liver Transplant Patient

간이식을 시행하지 않은 환자에서 발생한 담관 원주 증후군 1예

  • Jun, Sung-Gon (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Jeon, Seong-Ran (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Moon, Jong-Ho (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Cho, Young-Deok (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine)
  • 전성곤 (순천향대학교 의과대학 내과학교실, 소화기 연구소) ;
  • 전성란 (순천향대학교 의과대학 내과학교실, 소화기 연구소) ;
  • 문종호 (순천향대학교 의과대학 내과학교실, 소화기 연구소) ;
  • 조영덕 (순천향대학교 의과대학 내과학교실, 소화기 연구소)
  • Published : 2011.06.30
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Abstract

Biliary casts are uncommon but are typically seen in post-liver transplant patients, whereas very few cases have been reported in non-liver transplant patients. A 65-year-old man, who had not undergone a liver transplantation or other hepatobiliary surgery, presented with jaundice and fever. Radiological imaging studies showed diffuse thickening and enhancement of the intrahepatic duct with mild ductal dilatation and multiple linear filling defects. A percutaneous transhepatic cholangioscopy revealed severe bile duct inflammation and multiple biliary casts, which were removed with multiple percutaneous choledocoscopic procedures. The pathogenesis of the biliary casts in this patient was uncertain. However, we presumed that biliary tract infection with subsequent extensive cholangitis was an important predisposing factor in the cast formation. We report a case of biliary cast syndrome with no preexisting morbidity that was managed favorably with endoscopic removal.

담관 원주 증후군은 담도 찌꺼기가 담도의 형태를 따라 원주를 형성하는 질환으로 간이식을 시행받은 환자에서 드물게 발생하는 담도계 합병증이다. 담도폐쇄와 담도염이 흔히 동반되어 있고 이로 인한 허혈성 간담도 손상과 담즙 저류를 보이나 발병 기전은 아직 명확치 않다. 간이식을 시행하지 않은 경우에서는 매우 드물게 보고되고 있다. 담도계 수술 후 또는 수술 후 다량의 수혈을 받은 경우, 선행하는 동반 질환을 가진 환자에서 장기간 금식이나 완전 비경구 영양요법을 시행한 경우 또는 중증 감염으로 이환된 경우에서 발생한 보고가 있다. 저자들은 수술 과거력이 없으며 동반된 선행 질환이 뚜렷하지 않는 65세 남자에서 ERCP와 경피경간 담도경검사로 담관 원주 증후군으로 진단하였고, 반복적인 내시경 치료를 통해 담관 원주를 제거한 증례를 경험하여 문헌 고찰과 함께 보고한다.

Keywords

References

  1. Srinivasaiah N, Reddy MS, Balupuri S, Talbot D, Jaques B, Manas D. Biliary cast syndrome: literature review and a single centre experience in liver transplant recipients. Hepatobiliary Pancreat Dis Int 2008;7:300-303.
  2. Shah JN, Haigh WG, Lee SP, et al. Biliary casts after orthotropic liver transplantation: clinical factors, treatment, biochemical analysis. Am J Gastroenterol 2003;98:1861-1867. https://doi.org/10.1111/j.1572-0241.2003.07617.x
  3. McMaster P, Herbertson BM, Cusick C, Calne RY, Syrakos T, Marni A. The development of biliary "sludge" following liver transplantation. Transplant Proc 1979;11:262-266.
  4. Parry SD, Muiesan P. Cholangiopathy and the biliary cast syndrome. Eur J Gastroenterol Hepatol 2003;15:341-343. https://doi.org/10.1097/00042737-200304000-00001
  5. Gleeson FC, Czaja AJ, Baron TH. Successful endoscopic management of biliary cast syndrome in non-liver transplant patients. J Clin Gastroenterol 2008;42:752-755. https://doi.org/10.1097/01.mcg.0000225626.76544.67
  6. D'Haens GR, Ruchim MA, Goldberg MJ, Baker AL. Massive intra-hepatic and extra-hepatic bile cast formation after cholecystectomy. Gastrointest Endosc 1993;39:579-581. https://doi.org/10.1016/S0016-5107(93)70180-7
  7. Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Pilpilidis I, Paroutoglou G. Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient. World J Gastroenterol 2008;14:5223-5225. https://doi.org/10.3748/wjg.14.5223
  8. Byrne MF, Chong HI, O'Donovan D, et al. Idiopathic cholangiopathy in a biliary cast syndrome necessitating liver transplantation following head trauma. Eur J Gastroenterol Hepatol 2003;15:415-417. https://doi.org/10.1097/00042737-200304000-00013
  9. Lim BU, Kim HK, Chae SA, et al. A case of biliary cast with a characteristic finding on ERCP. Korean J Gastrointest Endosc 2003;27:254-257.
  10. Seo CJ, Jung JT, Han JM, et al. A case of biliary cast syndrome after cadaveric liver transplantation. Korean J Gastroenterol 2007;49:106-109.
  11. Suh JP, Lee IS, Chang JH, et al. A case of biliary cast syndrome with a biliary stricture and suppurative cholangitis after liver transplantation. Korean J Gastrointest Endosc 2007;35:281-286.
  12. Bak SH, Choi HS, Yang SY, et al. Obstructive jaundice due to biliary cast syndrome followed by orthotopic liver transplantation. Korean J Gastroenterol 2006;48:119-123.
  13. Starzl TE, Putnam CW, Hansbrough JF, Porter KA, Reid HA. Biliary complications after liver transplantation: with special reference to the biliary cast syndrome and techniques of secondary duct repair. Surgery 1977;81:212-221.
  14. Lee SP, Maher K, Nicholls JF. Origin and fate of biliary sludge. Gastroenterology 1988;94:170-176.
  15. McMaster P, Herbertson B, Cusick C, Calne RY, Williams R. Biliary sludging following liver transplantation in man. Tansplantation 1978;25:56-62. https://doi.org/10.1097/00007890-197802000-00004
  16. Waldram R, Walton RM, Calne RY. Bile composition and bile cast formation after transplantation of the liver in man. Transplantation 1975;19:382-387. https://doi.org/10.1097/00007890-197505000-00004
  17. Baron TH, Yates RM 3rd, Morgan DE, Eckhoff DE, Bynon JS. Biliary cast syndrome: successful endoscopic treatment. Gastrointest Endosc 2000;52:78-79. https://doi.org/10.1067/mge.2000.105064
  18. Kim HJ, Yoon KT, Bang SM, et al. Biliary cast successfully removed by percutaneous transhepatic cholangioscopy, and this developed in a patient who received orthotropic liver transplantation. Korean J Gastrointest Endosc 2006;33:381-384.
  19. Canete JJ, Aidlen JT, Uknis ME, Cicalese L. Images of interest. Hepatobiliary and pancreatic: biliary cast syndrome. J Gastroenterol Hepatol 2005;20:791. https://doi.org/10.1111/j.1440-1746.2005.03937.x