P3971 - Cirrhosis with a Bias - Unilateral Hepatic Involvement in Secondary Sclerosing Cholangitis

Sohini Samaddar, MBBS¹, Reem Salim, ², Jessica Wilson, ARNP¹, Nizar Talaat, MD¹
1University of Kansas Medical Center, Kansas City, KS; 2Univeristy of medical science and technology, Cairo, Al Qahirah, Egypt

Introduction: Secondary sclerosing cholangitis (SSC) is a progressive biliary disease that can result from ischemia, infections, and surgical complications, often progressing to cirrhosis involving both hepatic lobes. However, segmental SSC with unilateral cirrhosis is rarely reported.

Case Description/

Methods: A 36-year-old female presented in 2018 with biliary colic. Initial laboratory tests revealed ALT 101 U/L, AST 150 U/L, and ALP 150 U/L with normal total bilirubin. A HIDA scan showed cystic duct obstruction with associated cholecystitis. Following laparoscopic cholecystectomy, she developed a biliary leak that proved refractory to multiple ERCPs with common bile duct stenting and required percutaneous drain placements and serial external stent exchanges for three years. Although the biliary leak eventually resolved and her AST and ALT normalized, ALP remained persistently elevated in the 200s-300s U/L range. In 2021, MRCP revealed chronic right hepatic duct occlusion with segmental atrophy of the right hepatic lobe and compensatory hypertrophy of the left lobe. ERCP demonstrated a normal common bile, common hepatic and left hepatic ducts without opacification of the right posterior duct. In 2023, bilobar liver biopsies showed chronic cholestatic features with bile duct loss and cirrhosis confined to the right lobe and mild steatohepatitis with F1 fibrosis in the left lobe. Due to her right lobe cirrhosis, she is now undergoing surveillance for hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA).

Discussion: Biliary related cirrhosis often results from primary chronic liver diseases such as primary sclerosing cholangitis (PSC) and usually affects both hepatic lobes. SSC shares similar clinical and radiological findings as PSC but often has an identifiable etiology such as ischemia, infections, drugs, or biliary injuries. This case illustrates that cirrhosis may occasionally present in an isolated lobar distribution, as seen here with right lobe involvement and left lobe sparing. In patients with a history of complex hepatobiliary surgery, bilobar liver biopsy should be considered to better characterize the extent and pattern of hepatic injury. While the long-term implications of unilateral cirrhosis are not well established, it may be reasonable to consider surveillance for hepatocellular carcinoma and cholangiocarcinoma, particularly in the context of chronic biliary disease.

Disclosures:
Sohini Samaddar indicated no relevant financial relationships.
Reem Salim indicated no relevant financial relationships.
Jessica Wilson indicated no relevant financial relationships.
Nizar Talaat indicated no relevant financial relationships.

Sohini Samaddar, MBBS¹, Reem Salim, ², Jessica Wilson, ARNP¹, Nizar Talaat, MD¹. P3971 - Cirrhosis with a Bias - Unilateral Hepatic Involvement in Secondary Sclerosing Cholangitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.