Causes of a stricture in the bile duct:
(1) following surgery
(2) blunt or penetrating trauma
(3) following percutaneous or endoscopic biliary intubation
(4) pancreatitis (especially for the distal common bile duct)
(5) choledocholithiasis, especially with recurrent bacterial cholangitis
(6) tuberculosis
(7) parasitic infections of the bile ducts, including cryptosporidiosis in patients with HIV infection
(8) primary or secondary sclerosing cholangitis
(9) benign tumor or pseudotumor
(10) cholangiocarcinoma
(11) radiation injury
(12) abscess or inflammation in the subphrenic space
(13) recurrent pyogenic cholangitis (Oriental cholangiohepatitis)
(14) disease at the Ampulla/Papilla of Vater (papillary stenosis, chronic duodenal ulceration, other)
(15) congenital or acquired bile duct atresia
Rarely a patient may present with an idiopathic bile duct stricture, with no cause identified despite a complete evaluation.
The differential diagnosis includes:
(1) external compression
(2) parasitic infection without stricture
(3) impacted stone
Management depends on:
(1) the cause of the stricture
(2) whether localized, multifocal, or diffuse
(3) location
(4) reaction in the surrounding tissue
