CASE OF BILE-DUCT CARCINOMA OF THE HEPATIC HILUS WITH SEGMENTAL OBSTRUCTIVE CHOLANGITIS

Cholangitis is a risk factor for posthepatectomy liver failure and the refore should be treated aggressively by urgent biliary drainage befor e definitive liver surgery for bile duct carcinoma. We present a case of bile duct carcinoma of the hepatic hilus with segmental cholangitis . The patient was a 38-year-old man. Percutaneous transhepatic biliary drainage (PTBD) was performed in the left anterior, right anterior, a nd right posterior segmental ducts to alleviate jaundice and to evalua te the biliary system. One month after PTBD, the patient developed hig h fever with leukocytosis, suggesting the onset of segmental cholangit is. An urgent repeat PTBD was carried out at the caudate and left medi al segmental bile ducts. The bile juice was purulent, and the tube cho langiogram revealed miliary abscesses. After PTBD, cholangitis was sub sided, and extended Left hepatic lobectomy with caudate Lobectomy was performed. The postoperative recovery was uneventful and the patient h as been well for 13 months. We conclude that the onset of fever in pat ients with hilar bile duct cancer, PTBD catheters, and undrained bilia ry segments suggests the presence of segmental cholangitis.