par Deltenre, Pierre 
Référence Vascular Disorders of the Liver: VALDIG's Guide to Management and Causes, Springer International Publishing, page (35-47)
Publication Publié, 2021-01
Référence Vascular Disorders of the Liver: VALDIG's Guide to Management and Causes, Springer International Publishing, page (35-47)
Publication Publié, 2021-01
Partie d'ouvrage collectif
| Résumé : | Bile duct oxygenation depends exclusively on arterial blood supply. Therefore, injury to the arteries supplying the bile ducts may result in ischemic lesions. Many conditions are associated with ischemic cholangiopathy. Lesions are often localized to the middle third of the common bile duct or on the biliary confluence, the parts of the biliary tree that are most vulnerable to ischemic damage. Bile duct necrosis, biliary casts and biloma are frequently observed during acute stages. Later stages are characterized by diffuse and/or multiple stenoses of the bile duct. Eventually, secondary biliary cirrhosis may occur. Ischemic cholangiopathy should be differentiated from pure cholestasis accompanying conditions causing ischemia. For patients presenting with biliary strictures, differential diagnoses include primary sclerosing cholangitis, IgG4 cholangiopathy and cholangiocarcinoma. Therapeutic modalities aim at restoring arterial blood supply to the bile ducts in cases of hepatic artery thrombosis; and at restoring bile duct flow though biliary casts removal; and dilatation of strictures by endoscopic and/or percutaneous procedures. Surgical procedures may be needed for bile duct reconstruction. For patients with the most severe forms of bile duct injury or with decompensated biliary cirrhosis, liver transplantation is the ultimate option. |
