A CASE OF SECONDARY SCLEROSING CHOLANGITIS PRESENTED DIFFICULTIES IN DIFFERENTIATION FROM HILAR CHOLANGIOCARCINOMA

Abstract

A 71-year-old man who had undergone a choledocholithotomy 4 years previously was found having dilatation of the intrahepatic ducts by abdominal ultrasonography during clinical observation for diabetes mellitus. After percutaneous transhepatic biliary drainage was performed. a cholangiography showed a stenosis extending to the left hepatic duct and a bifurcation of branches of anterior and posterior segments from the hilus. Percutaneous transhepatic portography showed a stenosis of the left portal vein. With a diagnosis of hilar cholangiocarcinoma, an extended left lobectomy combined with caudate lobectomy, dissection of lymph nodes including paraaortic lymph nodes, and reconstruction with hepatico-jejunostomy were performed. Exproration of the resected specimen showed no malignancy but sclerosing cholangitis. Sclerosing cholangitis was classified into primary group or secondary group. This case is classified into secondary group becase of a past history of biliary surgery. Sclerosing cholangitis, especially the localized type like ours, presents difficulties in differentiation from cholangiocarcinoma. We have to take care in diagnosing sclerosing cholangitis.