Biliary stricture of the hepatic hilus is caused by malignant diseases in most cases. But we successfully diagnosed a case of hilar biliary stricture as benign preoperatively based on the findings of percutaneous transhepatic cholangioscopy (PTCS) and changes in the biliary image with time.
A 61-year-old woman was admitted to the hospital because of anemia, fever and obstructive jaundice. Percutaneous transhepatic biliary drainage revealed the severe hilar biliary stricture, cholelithiasis, choledocholithiasis and biliobiliary fistula connecting to the common hepatic duct and gallbladder. We diagnosed this case as inflammatory stricture due to cholecystitis, because the stricture gradually improved with time, and PTCS biopsies of mucosa of the gallbladder and fistula disclosed no malignancy. At the same time, carcinoma of the sigmoid colon and its liver metastasis were found spontaneously, and sigmoidectomy, left caudate lobectomy, lithotomy after choledochotomy and biopsy of the gallbladder were performed. Histopathological findings confirmed the diagnosis. After the operation, endoprosthesis with a catheter was carried out for the hilar biliary stricture. Authors recommend the use of PTCS for the diagnosis and treatment of hilar biliary stricture which presents difficulty to determine whether it is benign or not.