Late complications of the inadequate biliary surgery in patients with primary sclerotising cholangitis

Introduction: Primary sclerotising cholangitis (PSC) is a severe inflammatory disease that can involve both the intrahepatic and extrahepatic biliary ducts. Therefore every operation concerning the biliary area should be preceded by careful work-up to prevent unnecessary surgery.

Case1: A 31yrs old male was admitted to our department because of highly elevated liver enzymes. PSC was diagnosed at age of 13yrs. Until now ulcerative colitis has not been verified. Cholecystectomy and choledocho-duodenostomy was performed by mistake when the patient was 18yrs old. In the past 13yrs repeated attacks of cholangitis have occurred. Last time the stricture at the level of the choledocho-duodenostomy was so tight that Soehandra drain extractor was the only one that could be passed over the stricture, first. Nasobiliary lavage improved the condition of the patients.

Case2: In a 51yrs old male the first attack of cholestasis have occurred at the age of 38yrs. The cause was not found. Two years later cholecystectomy and choledochotomy with T-tube insertion and lymph node removal was performed by error. The ulcerative colitis was confirmed later. The ERCP which was performed only at the age of 51yrs, because of biliary abscesses revealed PSC and long stricture of the common hepatic duct at the probable level of the T-tube. Now we are trying to dilate this stricture by insertion of multiple plastic drains.

In summary: The only possibility the cure the PSC is liver transplantation. Therefore it is very important, if possible, not to perform operation at the common bile duct, which obviously decreases the chances of the later transplantation.