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Endoscopic nasobiliary drainage improves jaundice attack symptoms in benign recurrent intrahepatic cholestasis: A case report.
[benign recurrent intrahepatic cholestasis]
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
.
Diseases
Validation
Diseases presenting
"blood tests"
symptom
allergic bronchopulmonary aspergillosis
benign recurrent intrahepatic cholestasis
carcinoma of the gallbladder
cholangiocarcinoma
cushing syndrome
esophageal carcinoma
esophageal squamous cell carcinoma
lymphangioleiomyomatosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
systemic capillary leak syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
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