Ischemic cholangiopathy is damage to one or more bile ducts caused by inadequate blood flow.

Bile ducts (such as the hepatic ducts and the common bile duct), unlike the liver, are supplied with blood from only one major blood vessel, the hepatic artery. Thus, disruption of blood flow through the hepatic artery can prevent the bile ducts from obtaining enough oxygen. Consequently, the cells lining the ducts are damaged or die—a disorder called ischemic cholangiopathy. Blood flow can be disrupted by the following:

• Surgical trauma during liver transplantation or removal of the gallbladder by laparoscopy
• Injury from radiation therapy
• A disorder that makes blood more likely to clot (blood clotting disorder)
• A procedure to block a bleeding blood vessel that causes clot formation (embolization)

Ischemic cholangiopathy most commonly occurs in people who have had a liver transplant.

Symptoms and Diagnosis

The damaged bile duct narrows (causing a stricture) so that the flow of bile slows or is blocked. As a result, bile pigment (bilirubin) is retained, the skin and the whites of the eyes turn yellow (called jaundice), and the urine becomes dark. Because bile (containing pigment such as bilirubin) does not enter the small intestine, the stools become pale. Itching (pruritus) is common, often beginning in the hands and feet but usually affecting the whole body. Itching is especially worse at night. Bile duct infection (cholangitis–see Cirrhosis and Related Disorders: Symptoms) may also occur, producing abdominal pain, chills, and fever.

The diagnosis is based on the symptoms and abnormal blood test results, especially in people who have conditions that make ischemic cholangiopathy more likely (such as liver transplant recipients).

Ultrasonography helps doctors visualize the ducts, but the results may be inconclusive. Better definition often requires magnetic resonance imaging of the bile ducts (a procedure called magnetic resonance cholangiopancreatography, or MRCP) or endoscopic retrograde cholangiopancreatography (ERCP—see Diagnosis of Liver, Gallbladder, and Biliary Disorders: Imaging Tests). ERCP involves inserting a flexible viewing tube (endoscope) through the mouth and into the small intestine and injecting dye into the bile duct system.

Treatment

In addition to detecting narrowing of the bile ducts, ERCP can be used in treatment. A wire with a deflated balloon at its end is introduced through the endoscope. Doctors inflate the balloon to widen (dilate) the narrowing. A mesh tube (stent) is then inserted to keep the duct open.

Some people who have had a liver transplant require another transplant.

Last full review/revision December 2007 by Eldon A. Shaffer, MD