Ischemic necrosis of bile ducts complicating Schönlein–Henoch purpura

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Presentation transcript:

Ischemic necrosis of bile ducts complicating Schönlein–Henoch purpura Sheila Viola*, Martine Meyer‡, Monique Fabre§, Patrick Tounian∥, Roland Goddon¶, Pierre Dechelotte#, Jacques Valayer**, Max Gruner‡‡, Olivier Bernard* Gastroenterology Volume 117, Issue 1, Pages 211-214 (July 1999) DOI: 10.1016/S0016-5085(99)70569-X Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 1 Transhepatic cholangiogram obtained 8 months after the onset of disease in a child with Schönlein–Henoch purpura and cholestasis. Stenosis of the left primary hepatic duct and a bile leak near the bifurcation are visible. Gastroenterology 1999 117, 211-214DOI: (10.1016/S0016-5085(99)70569-X) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 2 A liver biopsy specimen at age 9, 8 months after the onset of Schönlein–Henoch purpura, shows portal and septal fibrosis and ductular proliferation suggestive of biliary disease (trichrome stain; original magnification 63×). Gastroenterology 1999 117, 211-214DOI: (10.1016/S0016-5085(99)70569-X) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 3 Repeat transhepatic cholangiogram obtained 35 months after the onset of Schönlein–Henoch purpura. The left hepatic duct is almost completely stenosed. Gastroenterology 1999 117, 211-214DOI: (10.1016/S0016-5085(99)70569-X) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 4 Native liver removed during transplantation. In the left parahilar region, bile ducts are irregular, dilated, and surrounded by fibrosis (B). Some ducts have been destroyed and replaced by scars. A network of arteries of various sizes can be seen, with fibromuscular hyperplasia (A). Portal phlebosclerosis is visible in the center of the field (V). Nerve hyperplasia is present with fibrosis (N) (H&E stain; original magnification 4×). Gastroenterology 1999 117, 211-214DOI: (10.1016/S0016-5085(99)70569-X) Copyright © 1999 American Gastroenterological Association Terms and Conditions

Fig. 5 Native liver removed during transplantation. In the hilum, there are vascular lesions with concentric fibrous thickening of small vessel walls reducing the diameter of the arterial lumina and subtotal occlusion with fibrosis (elastic-orcein stain; original magnification 12.5×). Gastroenterology 1999 117, 211-214DOI: (10.1016/S0016-5085(99)70569-X) Copyright © 1999 American Gastroenterological Association Terms and Conditions