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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
"which was suspected to be viral hepatitis"
symptom
benign recurrent intrahepatic cholestasis
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