Wakui Noritaka, Fujita Mitsuru, Oba Nobuyuki, Yamauchi Yoshiya, Takeda Yuki, Ueki Nobuo, Otsuka Takafumi, Nishinakagawa Shuta, Shiono Saori, Kojima Tatsuya
Departments of Internal Gastroenterology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan.
Exp Ther Med. 2013 Feb;5(2):389-394. doi: 10.3892/etm.2012.814. Epub 2012 Nov 16.
A 66-year-old male with unbearable pruritus and jaundice was admitted for detailed examination. Blood tests on admission showed increased bilirubin with a dominant direct fraction. Ultrasonography and computed tomography performed subsequent to admission showed no narrowing or distension of the bile ducts. As the jaundice symptoms were not improved by the oral administration of ursodeoxycholic acid (300 mg/day) that had been started immediately after admission, endoscopic retrograde cholangiopancreatography (ERCP) was performed on hospital day 14. This also showed no abnormalities of the bile ducts. After considerating its potential effects for improving jaundice, endoscopic nasobiliary drainage (ENBD) was performed on the same day and was followed by immediate improvements in pruritus and jaundice. Detailed examinations were performed to identify the cause of the jaundice, which was suspected to be viral hepatitis, autoimmune hepatitis or drug-induced liver injury, however, there were no findings suggestive of any of these conditions. Following a further increase in bilirubin levels, confirmed by additional blood tests, a liver biopsy was performed. Histological findings were consistent with the histological features of benign recurrent intrahepatic cholestasis (BRIC). Although ursodeoxycholic acid is used as a first-line treatment in most cases of BRIC, ENBD should also be considered for patients not responding to this treatment.
一名66岁男性因难以忍受的瘙痒和黄疸入院进行详细检查。入院时血液检查显示胆红素升高，以直接胆红素为主。入院后进行的超声检查和计算机断层扫描显示胆管无狭窄或扩张。由于入院后立即开始口服熊去氧胆酸（300毫克/天），黄疸症状未得到改善，因此在住院第14天进行了内镜逆行胰胆管造影（ERCP）。检查也未发现胆管有异常。考虑到其对改善黄疸的潜在作用，当天进行了内镜鼻胆管引流（ENBD），随后瘙痒和黄疸立即得到改善。进行了详细检查以确定黄疸的病因，怀疑是病毒性肝炎、自身免疫性肝炎或药物性肝损伤，但未发现提示这些情况的任何迹象。经进一步血液检查证实胆红素水平进一步升高后，进行了肝活检。组织学检查结果与良性复发性肝内胆汁淤积（BRIC）的组织学特征一致。尽管在大多数BRIC病例中熊去氧胆酸用作一线治疗，但对于对此治疗无反应的患者也应考虑ENBD。
