Case Report
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World J Gastroenterol. Dec 14, 2014; 20(46): 17680-17685
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17680
Sclerosing cholangitis secondary to bleomycin-iodinated embolization for liver hemangioma
Shuo Jin, Xiao-Ju Shi, Xiao-Dong Sun, Si-Yuan Wang, Guang-Yi Wang
Shuo Jin, Xiao-Ju Shi, Xiao-Dong Sun, Guang-Yi Wang, Department of Hepatobiliary and Pancreatic Surgery, the First Norman Bethune Hospital Affiliated to Jilin University, Changchun 130021, Jilin Province, China
Si-Yuan Wang, Department of Surgery Intensive Care Unit, Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing 10010, China
Author contributions: Jin S and Wang GY designed the study; Jin S, Sun XD, Shi XJ, Wang SY and Wang GY performed the surgical procedures; and Jin S drafted the manuscript.
Correspondence to: Guang-Yi Wang, MD, Professor, Department of Hepatobiliary and Pancreatic Surgery, The First Norman Bethune Hospital Affiliated to Jilin University, 71 Xinmin Street, Changchun 130021, Jilin Province, China.
Telephone: +86-431-88782345 Fax: +86-431-88782345
Received: May 5, 2014
Revised: June 17, 2014
Accepted: July 22, 2014
Published online: December 14, 2014

Sclerosing cholangitis (SC) is a rarely reported morbidity secondary to transcatheter arterial chemoembolization (TACE) with bleomycin-iodinated oil (BIO) for liver cavernous hemangioma (LCH). This report retrospectively evaluated the diagnostic and therapeutic course of a patient with LDH who presented obstructive jaundice 6 years after TACE with BIO. Preoperative imaging identified a suspected malignant biliary stricture located at the convergence of the left and right hepatic ducts. Operative exploration demonstrated a full-thickness sclerosis of the hilar bile duct with right hepatic duct stricture and right lobe atrophy. Radical hepatic hilar resection with right-side hemihepatectomy and Roux-en-Y hepaticojejunostomy was performed because hilar cancer could not be excluded on frozen biopsy. Pathological results showed chronic pyogenic inflammation of the common and right hepatic ducts with SC in the portal area. Secondary SC is a long-term complication that may occur in LCH patients after TACE with BIO and must be differentiated from hilar malignancy. Hepatic duct plasty is a definitive but technically challenging treatment modality for secondary SC.

Keywords: Sclerosing cholangitis, Secondary, Transcatheter arterial chemoembolization, Bleomycin-iodinated oil, Liver cavernous hemangioma, Hilar stricture, Differential diagnosis, Definitive surgery

Core tip: Transcatheter arterial chemoembolization (TACE) with bleomycin-iodinated oil, a minimally invasive interventional treatment modality, is generally safe for treating liver cavernous hemangioma. Sclerosing cholangitis (SC) is a rare complication occurring after TACE. Operative exploration was indicated for our patient as preoperative imaging examination could not exclude the possibility of malignant hilar biliary stricture. Diagnosis of SC depends on the presence of chronic inflammation of the bile duct with characteristic features of sclerosis after primary SC is ruled out. Definitive treatment included radical hepatic hilar resection with hepatectomy and bile duct reconstruction.