Yamahata Yuto, Yasuda Jungo, Shiozaki Hironori, Futagawa Yasuro, Okamoto Tomoyoshi, Ikegami Toru
Department of Surgery, Jikei University Daisan Hospital, Komae, Tokyo, Japan.
Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0048. Epub 2025 Feb 20.
Biliary intraepithelial neoplasia (BilIN) is defined as a bile duct epithelial tumor with intraductal papillary neoplasia of the bile duct. BiIlN is a precancerous lesion of intrabiliary neoplasia. We performed laparoscopic hepatic resection for recurrent cholangitis due to intrahepatic lithiasis and diagnosed BilIN. This case suggests that it is necessary to consider the possibility of malignancy in cases of repeat cholangitis due to intrahepatic lithiasis.
A 34-year-old man developed cholecystitis due to gallstones at the age of 25 years and underwent laparoscopic cholecystectomy at the age of 26 years. One year later, cholangitis developed, and 2 years later, acute pancreatitis developed due to bile duct stones. Three years later, at the age of 31 years, he underwent endoscopic lithotripsy for bile duct stones and cholangitis. At that time, intrahepatic lithiasis was also detected in segment 6, but there was no stricture in the bile duct, and he was kept under observation. Three years later, at the age of 34 years, cholangitis in the bile duct of segment 6 was observed, and endoscopic nasobiliary drainage was performed. At that time, no strictures or common bile duct stones were found in bile duct of segment 6; however, we decided to perform laparoscopic hepatic resection of the ventral region of segment 6 because of the recurrent cholangitis. Pathological examination revealed bile duct inflammation and BilIN-1 in the bile duct epithelium; the bile duct stump was negative.
We experienced a case of a young patient with recurrent cholangitis due to intrahepatic lithiasis and diagnosed BilIN after laparoscopic hepatectomy. In such a case, it is also necessary to select a strategy that considers the coexistence of precancerous lesions, such as BilIN.
胆管上皮内瘤变（BilIN）被定义为一种伴有胆管内乳头状瘤变的胆管上皮肿瘤。BilIN是胆管内肿瘤的癌前病变。我们对一名因肝内结石导致复发性胆管炎的患者进行了腹腔镜肝切除术，并诊断出BilIN。该病例提示，对于因肝内结石导致的复发性胆管炎病例，有必要考虑恶性肿瘤的可能性。
一名34岁男性在25岁时因胆结石患上胆囊炎，并于26岁时接受了腹腔镜胆囊切除术。一年后，胆管炎发作，两年后，因胆管结石引发急性胰腺炎。三年后，在31岁时，他因胆管结石和胆管炎接受了内镜碎石术。当时，在6段也检测到肝内结石，但胆管无狭窄，遂对其进行观察。三年后，在34岁时，观察到6段胆管炎，遂进行了内镜鼻胆管引流。当时，6段胆管未发现狭窄或胆总管结石；然而，由于复发性胆管炎，我们决定对6段腹侧区域进行腹腔镜肝切除术。病理检查显示胆管炎症和胆管上皮内BilIN-1；胆管残端为阴性。
我们遇到一例因肝内结石导致复发性胆管炎的年轻患者，在腹腔镜肝切除术后诊断为BilIN。在这种情况下，还需要选择一种考虑癌前病变如BilIN共存的策略。
