Biliary stricture is a condition involving narrowing of the
bile duct. This narrowing can cause blockage of
bile into the
small intestines.
Many things are associated with
biliary stricture, however it is most commonly the result of an
abdominal injury during
surgery. It can also come about as the result of
pancreatitis,
abdominal trauma,
gallstones in the
bile duct, an
infection from a leakage of
bile, or
cancer.
As mentioned above, those who have had a previous abdominal
surgery are at the highest risk. In terms of the general
population, the incidence of
biliary stricture is 2 in 10,000.
That depends. I can only speak for myself, however in talking to my
doctor and reading up on the subject I do not seem to be much different from most other sufferers (except in that I have refused the commonly accepted
treatment for the condition).
The
pain comes in attacks. The attacks (for me) tend to come between 4:00 and 9:00 AM, and there is a huge pain which extends from my
belly button to below my
breast line. I
sweat, but I
shiver, and feel
nauseous and many times will
vomit. When vomiting occurs, there is a mucousy foam, then the
egg yolk consitency
bile (which tastes VERY, VERY bad). After
emesis, I usually feel better. If I do not
vomit, the pain will usually last for one to three hours. This pain can be somewhat relieved by laying on my
stomach with a
pillow underneath providing pressure on the area of pain. Only on two occasions have I become
jaundiced during an attack.
With that said, the most common reported symptoms of
biliary stricture are:
A
doctor may suspect
biliary stricture if a recent
cholestcystectomy patient experiences the
symptoms noted above. The final
diagnosis is done with a procedure called
endoscopic retrograde cholangiopancreatography (
ERCP). An
endoscope is inserted through the mouth and down the
throat and to
duodenum while under local
anesthesia and
sedatives.
Strictures can be visualized by injecting contrast solution and monitoring via
x-ray the progress of the solution through the
biliary system.
Most people with
biliary stricture are treated with the same
ERCP procedure which provided diagnosis, and often at the same time (often
biliary stricture is assumed by process of elimination before-hand). Special tools are inserted into the
endoscope which can cut
scar tissue, break up
gallstones, or stretch narrowed passages.
For those who do not wish to undergo the surgical procedure, in many cases
nitroglycerine can be used to halt an attack. Taken at the onset of pain, I experienced a total absence of symptoms by the time the side-effects of the
nitro wore off (a rush of
headache and dizzyness).
My doctor tells me I am chicken for not doing the ERCP. I admit it. Bawk bawk bawk. My reasoning is this: apparently that area is easily enough injured that it's a common after-effect of abdominal surgery. Thus, in my mind, it is counter-intuitive to undergo more surgery.
For myself, I have made a decision and it is not one I would recommend to anyone else suffering this condition. The pain is intense and incredible, and the ERCP is a very effective method of treatment which is usually successful.
The
ERCP procedure is usually succesful, and only 10% of patients will experience a recurrence of symptoms.
References:
- http://www.healthcentral.com/mhc/top/000220.cfm
- http://www.emedicine.com/med/byname/bile-duct-strictures.htm