Biliary cast syndrome in portal hypertensive biliopathy: direct cholangioscopic findings and endoscopic therapy with metal stent

Abstract

A 61-year-old man with asthma, diabetes mellitus, cirrhosis secondary to chronic hepatitis C virus (HCV) infection, and hepatocellular carcinoma (HCC), was admitted to our hospital because of progressive abdominal pain and jaundice of 7 days duration. On clinical examination, the patient had abdominal distention, tenderness in the right upper quadrant, and jaundice. His hemoglobin was 8.7 mg/dL; hematocrit, 25 %; white blood cells, 1.7 × 109/L; international normalized ratio (INR), 1.4; total bilirubin, 15 mg/dL; direct bilirubin, 7.6 mg/dL; indirect bilirubin, 7.4 mg/dL; and alkaline phosphatase, 65 IU/L. The remaining laboratory parameters were within reference ranges