BILIARY ABNORMALITIES ASSOCIATED WITH EXTRAHEPATIC PORTAL VENOUS OBSTRUCTION

We prospectively studied 21 consecutive patient with extrahepatic port al venous obstruction for evidence of biliary tract disease. Two patie nts were firs seen with extrahepatic cholestasis; another had recurren t cholangitis. All three patients with clinical manifest biliary disea se were adults. Another five patients had icterus on clinical examinat ion. Live function tests revealed elevated bilirubin levels in 1 patie nts (66.6%), elevated alkaline phosphatase level in 17 (80.9%) and ele vated serum ALT levels in (38.0%). Endoscopic retrograde cholangiograp hy revealed abnormal findings in 17 patients (80.9%). The changes invo lved the common bile duct (66.6%) more often than they did the hepatic bile ducts (38.1%). Cholangiographic abnormalities included stricture s (52.4%), caliber irregularity (23.8%), segmental upstream dilatation (42.8%), ectasia (9.5%), collateral veins causing extraluminal bile d uct impressions (14.3%), displacement of ducts (9.5%), angulation of d ucts (4.7%) and pruning of intrahepatic ducts (9.5%). The pathogenesis of such cholangiographic abnormalities is unknown. However, possible factors in such changes include collateral veins bridging the blocked portal vein, causing bile duct impressions; fibrous scarring of porta hepatis, causing angulation of bile duct; and ischemic injury to bile duct, leading to stricture formation and caliber irregularity. Biliary disease is important in the clinical outcome of patients with extrahe patic portal venous obstruction because variceal sclerotherapy has pro longed the life expectancies of such patients.