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Abstract

Introduction

Radiation-induced biliary damage, including strictures, stenosis, cholangitis, and posthepatic cholestasis, is a rare complication of radiation therapy reported most frequently in the context of hepatobiliary cancers and other upper abdominal mal ignancies.1-3 This complication often occurs with a delayed presentation, with a variable latency period ranging from months to as late as decades after treatment.1-4 Histologic examination demonstrates segmental bile duct wall thickening, cholestasis, fibrosis, and features consistent with radiation injury.1,5 Most reported cases involve the common bile duct and major hepatic ducts, where endoscopic and percutaneous interventions remain feasible. These are identified during surveillance imaging, though symptomatic presentations may include cholangitis, obstructive jaundice, and elevated liver enzymes.6,7 Far less recognized are scenarios in which radiation fibrosis exclusively involves isolated sectoral bile ducts – a distribution that severely limits conventional drainage options and creates a substrate for recurrent biliary sepsis. Powerski et al. demonstrated no impact on long-term survival in patients who developed this complication when treatment was rapidly initiated.4 Yet this reassurance presupposes timely recognition and accessible anatomy, which may not hold when strictures are confined to sectoral ducts and present years after the inciting radiation.

We present a case of a patient in whom treatment of primary and secondary neoplasms resulted in sectoral bile duct strictures within the radiation field, leading to intractable intrahepatic pyogenic abscesses requiring multiple readmissions and drainage procedures. This case highlights the morbidity and mortality associated with the delayed presentation of an underrecognized complication of postradiation fibrosis exclusively involving isolated sectoral bile ducts and underscores the need for heightened vigilance for delayed radiation complications, early involvement of a multidisciplinary team, and proactive nutritional optimization before the onset of severe inanition.

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