Common Bile Duct Stricture

by Robert Landry
(Cookeville, TN)

I am a 61 year old Physician who has spent the last eight months involved in sorting out surreptitiously identified elevation of hepatic enzymes. These enzymes had been elevated in the past due to a common bile duct stone following cholecystectomy. That was 2008 and an ERCP removed the stone and resolved the cholestatic hepatic enzyme elevation. The new elnzyme elevations in 2012 presented a diagnostic dilemma that eventually resulted in identification of a new common bile duct stricture. The rather distal location of the stricture caused an unacceptable suspicion of cholangiocarcinoma by an experienced and highly trained surgeon who heads the liver transplant division of a highly respected academic center. This surgeon convinced me by reviewing serial cholangiograms that cholangiocarcinoma was a significant possibility. We then agreed to proceed with a Whipple surgery for curative resection if carcinoma in situ existed or a definitive diagnosis if no carcinoma.
I am now 22 days out from the surgery. The pathology revealed intramural ductal cell dysphasia but no carcinoma. So there is a possibility that the stricture could have eventually progressed to carcinoma. My recovery has gone well though nonetheless difficult. I was discharged from the hospital after a week. I have tried to regain strength and stamina by walking and seemed to be making progress in the first week at home. Subsequently I have experienced increased fatigue and have had to decreas the walking. I continue to have an uncomfortable "tightness" across my upper abdomen. As well I have to eat cautiously to avoid discomforting bloating and spasmodic stomach pain. Though disappointed that I have not steadily improved in strength and stamina, I am hopeful this is a temporary set back. I would like to return to work in the next week, but this may have to be further delayed.