Bile duct varices in the absence of portal hypertension signs.
Previous reports have shown that unrecognized or incidental bile duct varices have been reported as being related to hazardous complications and difficulties during surgery or other interventional procedures. A 32-year-old Indian female patient with no previous symptoms and signs suggestive of portal hypertension was admitted for an elective laparoscopic cholecystectomy for biliary colic. Bile duct varices were incidentally recognized during the operation. For the sake of safety, the surgery was converted to a conventional approach. Postoperatively, a detailed history revealed catheterization of the umbilical vein during the newborn period. Subsequently, contrast-enhanced computer tomography scanning showed extrahepatic portal vein thrombosis and cavernous transformation, while an upper gastrointestinal tract endoscopy did not reveal any evidence of esophageal varices. Bile duct varices should be excluded in patients with symptoms and signs suggestive for portal hypertension. Moreover, the present case addresses the fact that bile duct varices should also be suspected in asymptomatic patients with a history suggestive for extrahepatic portal vein thrombosis. Intraoperative recognition of bile duct varices requires a careful anatomical approach to the hepatoduodenal ligament to avoid hazardous complications.
Griniatsos
J
J
Upper GI and Laparoscopic Unit, Ealing Hospital, Southall, Middlesex, London, United Kingdom. johngrin@hotmail.com
Arbuckle
J
J
Bhalla
A
A
Karvounis
E
E
Isla
A
A
D000328:Adult; D001652:Bile Ducts / Q000098:blood supply*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis; D011169:Portal Vein; D013514:Surgical Procedures, Operative; D014648:Varicose Veins / Q000209:etiology / Q000601:surgery*; D020246:Venous Thrombosis / Q000150:complications