Case Report Recurrent cholangitis caused by common bile duct compression due to hepatic artery variation

Many different benign and malignant diseases can cause extrahepatic biliary duct obstruction. Common causes include calculus of the bile duct, stenosis, and tumors. Bile duct obstruction is often complicated bybacterial infection due to acute cholangitis, leading toan increase in the bile duct pressure and entry ofa large number of bacteria and toxins into the blood circulation. Consequently, a severe infection of the biliary tractoccurs, resulting in acute abdomen; this infectionis a major benign biliary tract disease and the most common direct cause of death. In biliary surgery, anatomic variation is often noted in the biliary ductarea, and anatomic variation of the gallbladder artery or hepatic artery is common. However, extrahepatic bile duct compression by the proper hepatic artery has rarely been reported. A 56-year-old woman was admitted to our department with a 2-year history of repeated upper abdominal pain associated with fever. Four years before her admission, she had undergone laparoscopic cholecystectomy. She experienced recurrent abdominal pain every 1 or 2 months, often accompanied by fever (maximum temperature, 40.5°C) and the passage of dark-yellow urine. Gastroscopy showed chronic non-atrophic gastritis. Abdominal ultrasonic examination and computed tomography did not show any abnormality. However, magnetic resonance cholangiopancreatographyshowedan angulated common bile duct with no stone, tumor, or other disease. Because the cause of the biliary obstruction was unclear, surgical exploration was decided fora clear diagnosis and determination of the appropriate treatment.