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An ischemic basis for biliary strictures.

Three case reports reflecting a probable ischemic basis for biliary strictures are presented. A stricture occurring after biliary-enteric anastomosis following low division of the bile duct and another after relatively low division of the bile duct are explained on the basis of the tenuous blood supply to the supraduodenal bile duct from above. It is postulated that these strictures could have been avoided had the bile duct been divided at a higher level originally and had adequate back-bleeding from the transected upper bile duct been checked prior to performing the anastomosis. The stricture in the third patient probably occurred because the damaged duct segment was used for the anastomosis. The stricture could probably also have been avoided by higher transection of the duct.