To the Editors.—We read with great interest the recent article "Caustic Sclerosing Cholangitis: A Complication of Surgical Treatment of Hydatid Disease of the Litter."1 We believe that there are some points that require comment.
Because of the cystic-biliary communications, cyst contents may drain into the ducts and cause obstruction and cholangitis, which almost certainly accelerates the progressive fibrosis of the biliary tract, thus producing marked secondary sclerotic changes.2 In this report by Belghiti et al,1 frank intrabiliary rupture was described in only one patient treated by T-tube drainage. In our experience, the T tube provides only temporary drainage. After removal of the tube, overlooked debris may obstruct the duct and cause cholangitis. Proper treatment with a wide choledochoduodenostomy prevents further obstructions and secondary sclerosing cholangitis.
The process of ductal fibrosis leads to rigidity of the ducts, so that, in a minority of cases, even long-standing obstruction