Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Etiologies include:-Postoperative-Trauma-Chronic pancreatitis-Cholelithiasis or choledocholithiasis-Primary sclerosing cholangitis-Sphincter of Oddi stenosis-Duodenal ulcer-Crohn disease-Viral infection-Drug toxins• 80% of cases occur post-cholecystectomy• 10% of postoperative cases are recognized in first week, whereas 70% are recognized after 6 months• Chronic pancreatitis < 10% of cases (3-29% of patients with chronic pancreatitis) +++ Symptoms and Signs + • Fever• Abdominal pain• Jaundice +++ Laboratory Findings + • Hyperbilirubinemia• Elevated alkaline phosphatase level• Leukocytosis +++ Imaging Findings + • Right upper quadrant US: Associated biloma with postoperative stricture, biliary dilatation, atrophic/calcified pancreas• CT: Shows associated biloma with postoperative ductal injury, biliary dilatation, atrophic/calcified pancreas• Magnetic resonance cholangiopancreatography (MRCP) or percutaneous transhepatic cholangiogram (PTC)-Reveals long tapered stricture in intrapancreatic bile duct when stricture is caused by chronic pancreatitis-Long stricture when associated with postoperative or trauma + • Recent operation• History of pancreatitis• History of choledocholithiasis +++ Rule Out + • Biliary, pancreatic, or ampullary malignancy + • History and physical exam• CBC• Liver function tests• Right upper quadrant US• CT• MRCP• PTC• Endoscopic US if question of pancreatic head mass +++ When to Admit + • Cholangitis• Infected biloma or bile peritonitis +++ Surgery +++ Indications + • Hepaticojejunostomy for most postoperative or traumatic strictures• Choledochoduodenostomy or choledochojejunostomy for chronic, pancreatitis-induced strictures• Balloon dilatation indicated for some anastomotic biliary strictures post-repair +++ Contraindications + • If pancreatic malignancy is suspected, pancreaticoduodenectomy should be done +++ Complications + • Recurrent stricture/biliary leak• Cholangitis +++ Prognosis + • Excellent in 70-90% following surgical reconstruction• Poor for balloon dilatation as primary therapy for strictures except as treatment for early post-repair stricture +++ References ++Beckingham IJ: ABC of diseases of liver, pancreas, and biliary system. Gallstone disease. BMJ 2001;322:91. [PubMed: 11154626] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth