Laparoscopic findings of the liver in the diagnosis of primary biliary cirrhosis: "reddish patch", a laparoscopic feature in the asymptomatic stage.

Abstract

The laparoscopic findings of the livers of 12 patients with primary biliary cirrhosis (PBC), including six asymptomatic and six symptomatic cases, were investigated. On the liver surface of asymptomatic PBC, we found a laparoscopic appearance, consisting of reddish patches of irregular shape, ranging from 0.5 to 3 cm in diameter, and not evenly distributed. Five of six cases of asymptomatic PBC had reddish patches in our series. From serial laparoscopic observations, the patches were found to lose some of their reddish tone and to develop protuberances with vaguely outlined white markings in each reddish areas. The protuberances and white markings are characteristic appearances of the liver surface in more advanced PBC cases. The transition of reddish patches to protuberances with white markings coincided with progression among histopathological stages in PBC classified by Scheuer. A histometrical examination showed that areas with reddish patches had less advanced changes of intrahepatic bile ducts. As a result, we propose that laparoscopic findings of the liver have a value in the diagnosis of PBC and "reddish patch" is considered a laparoscopic feature which has no been described in asymptomatic PBC.