title: [Primary sclerosing cholangitis presenting as recurrent cholangitis and right hepatic duct outpouching].
abstract: Primary sclerosing cholangitis (PSC) may have an atypical mode of presentation with recurrent cholangitis and diverticulum-like outpouchings of the hepatic ducts; a high clinical suspicion is required to confirm the diagnosis instead of ascribing cirrhosis to a secondary cause as a result of the biliary stasis propitiated by the biliary cysts. We describe the case of a 63-year old woman with a one-year history of episodes of cholangitis and a persistent elevation of alkaline phosphatase. The endoscopic retrograde cholangiopancreatography and a magnetic resonance cholangiography showed strictures of the intrahepatic biliary tract compatible with PSC and a diverticulum-like outpouching of the right hepatic duct. A liver biopsy revealed cirrhosis. Initial management consisted of antibiotics, a sphincterotomy and the placement of a biliary plastic stent, however, the patient continued to have recurrent cholangitis and finally, the cyst was resected.
authors.affiliation: Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México. scorpiomv_16@hotmail.com
authors.forename: Carlos
authors.initials: C
authors.lastname: Moctezuma-Velázquez
authors.forename: Angela
authors.initials: A
authors.lastname: Saúl-Pérez
authors.forename: Eric
authors.initials: E
authors.lastname: López-Méndez
mesh_terms: D002761:Cholangitis / Q000209:etiology; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006500:Hepatic Duct, Common / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D012008:Recurrence