What is a Biliary Stricture / Bile Duct Stricture?

Biliary stricture is a condition involving narrowing of the bile duct. This narrowing can cause blockage of bile into the small intestines.

What Causes Biliary Stricture?

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.

Who Gets Biliary Stricture?

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.

How Does Biliary Stricture feel?

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:

How is Biliary Stricture Diagnosed?

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.

What Is the Treatment?

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.

What is the Prognosis?

The ERCP procedure is usually succesful, and only 10% of patients will experience a recurrence of symptoms.
  • http://www.healthcentral.com/mhc/top/000220.cfm
  • http://www.emedicine.com/med/byname/bile-duct-strictures.htm

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