[Xanthomatosis and extreme hypercholesterolemia after laparoscopic cholecystectomy. Total reversibility following surgical treatment of iatrogenous stenosis of the common bile duct].
BACKGROUND
Hypercholesterolemia and xanthomatosis are known complications of chronic cholestasis. This is the first report on xanthomatosis and severe hypercholesterolemia caused by common bile duct stenosis following laparoscopic cholecystectomy.


METHODS
Laparoscopic cholecystectomy was performed in a 32-year old woman because of numerous tiny gallstones. Bile leakage was observed in the early postoperative period which stopped spontaneously. Six months later itching, progressively increasing serum bilirubin level, cholestasis syndrome, xanthelasma and widespread eruptive xanthomatosis developed in a few months. The cholesterol level was extremely high (92.3 mmol/l), while the triglyceride level was normal. Though the ultrasound and the cholangio-MR did not showed any dilatation of bile ducts, the ERCP verified a 2 mm long, hair's-breadth thin stenosis of choledochus in the level of cystic duct. Primary biliary cirrhosis and primary sclerosing cholangitis were excluded, no evidence for familial hypercholesterolemia was found. Choledochojejunostomy was performed and the patient became complaint- and symptom-free within two months. All xanthomas disappeared, the extremely high cholesterol level gradually decreased to the normal level, and all the laboratory data became normal. The anticholesterol antibody level was undetectable at presentation, but later reached the level of the healthy controls.


CONCLUSIONS
The presented case is an example for laparoscopic cholecystectomy caused bile duct stenosis and for extra-hepatic cholestasis induced xanthomatosis and severe hypercholesterolemia. The bile leakage as early complication of bile duct damage may predict the later developed stenosis. Even severe xanthomatosis and extreme hypercholesterolemia can be totally reversible following elimination of biliary obstacle.
Tímea
Csák
C
Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Belgyógyászati Klinika, Budapest. csatim@bel1.sote.hu
Folhoffer
Anikó
A
Horváth
Andrea
A
Osztovits
János
J
Görög
Dénes
D
Kóbori
László
L
Papp
János
J
Szalay
Ferenc
F
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D001651:Cholestasis, Extrahepatic / Q000150:complications* / Q000209:etiology; D003135:Common Bile Duct / Q000473:pathology* / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000150:complications / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000209:etiology*; D008103:Liver Cirrhosis / Q000473:pathology; D014973:Xanthomatosis / Q000209:etiology*