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1.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431439

RESUMO

We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing 'catastrophic healthcare expenditure', an economic global health quandary much ignored.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/economia , Coledocolitíase/terapia , Tratamento Conservador/economia , Acesso aos Serviços de Saúde/economia , Icterícia Obstrutiva/terapia , Coledocolitíase/complicações , Coledocolitíase/diagnóstico , Coledocolitíase/economia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Tratamento Conservador/métodos , Países em Desenvolvimento/economia , Progressão da Doença , Feminino , Mão de Obra em Saúde/economia , Hospitais Privados/economia , Hospitais Públicos/economia , Humanos , Icterícia Obstrutiva/economia , Icterícia Obstrutiva/etiologia , Pessoa de Meia-Idade , Paquistão , Cuidados Paliativos , Índice de Gravidade de Doença , Tempo para o Tratamento/economia , Ultrassonografia
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431462

RESUMO

Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the pancreas but occasionally can involve surrounding structures (1.9%-6.6%), like bile duct and duodenum, and are labelled as IPMN with invasion. Jaundice as a manifestation of IPMN is not common (4.5%). It can present as jaundice as a result of invasion of common bile duct (CBD) resulting in stricture formation or uncommonly as a result of fistulising to CBD with resultant obstruction of CBD by thick mucin secreted by this tumour. As only few cases (around 23) of mucin-filled CBD are reported in the literature. We are presenting our experience in dealing a rare case of obstructive jaundice caused by IPMN fistulising into CBD, highlighting the difficulties faced in managing such case, especially with regards to biliary drainage and what can be the optimum management in such cases.


Assuntos
Adenocarcinoma Mucinoso/complicações , Antibacterianos/administração & dosagem , Colangite/terapia , Drenagem/instrumentação , Icterícia Obstrutiva/etiologia , Neoplasias Pancreáticas/complicações , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patologia , Fístula Biliar/diagnóstico , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Colangite/diagnóstico , Colangite/etiologia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/patologia , Ducto Colédoco/cirurgia , Feminino , Humanos , Icterícia Obstrutiva/terapia , Pessoa de Meia-Idade , Mucinas/metabolismo , Invasividade Neoplásica , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiologia , Fístula Pancreática/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Stents , Resultado do Tratamento
3.
Acta Gastroenterol Belg ; 83(3): 488-490, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33094600

RESUMO

BACKGROUND: Biliary system ascariasis can be a rare cause of acute abdomen. PATIENT REPORT: A 70-year-old woman presented with abdominal pain for two weeks. She complained of a right upper quadrant (RUQ) pain, intermittent vomiting and weight loss. Physical examination showed RUQ and epigastric tenderness without rebound tenderness or guarding. Laboratory finding exhibited leukocytosis and mildly elevated liver enzymes. RESULTS: Abdominal sonography showed distended gallbladder and a tubular lesion inside the common bile duct (CBD) in favor of a parasitic lesion. A large ascaris roundworm and blood clots were extracted from the CBD by endoscopic retrograde cholangiopancreatography and sphincterotomy. After 7 days, the disease process was complicated with a subhepatic abscess formation which was managed conservatively. Finally, the patient was discharged home in fair condition after 12 days of hospitalization. CONCLUSIONS: Ascariasis should be considered in endemic areas and early endoscopic intervention and medical therapy can be effective for extrahepatic involvement.


Assuntos
Abscesso , Ascaríase , Abscesso/etiologia , Idoso , Ascaríase/complicações , Ascaríase/diagnóstico , Ascaríase/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Feminino , Humanos , Ultrassonografia
4.
Cir. pediátr ; 33(4): 177-182, oct. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195128

RESUMO

OBJETIVO: La unión biliopancreática anómala (UBPA) es una malformación congénita caracterizada por un canal común pancreatobiliar largo que impide el adecuado funcionamiento del esfínter de Oddi. Su diagnóstico en niños se realiza comúnmente mediante colangiopancreatografía por resonancia magnética (CPRM). Se asocia a dilatación biliar congénita, pancreatitis y tumores de la vesícula y la vía biliar en la edad adulta. Los estudios en población occidental son escasos; debido a su morbilidad, resulta de relevancia la búsqueda en población pediátrica occidental. Este estudio pretende buscar e identificar la presencia de unión biliopancreática anómala mediante CPRM de pacientes pediátricos con enfermedad de la vía biliar o pancreática, al igual que identificar otros factores asociados. MÉTODOS: Se midió por CPRM la longitud del canal común, el conducto pancreático y el diámetro de la vía biliar de 41 pacientes pediátricos con patología biliar o pancreática. RESULTADOS: El canal común solo pudo ser medido en el 17,6% de los casos, de los cuales el 50% tuvo una longitud >8 mm, siendo todos ellos pacientes femeninos con dilatación biliar congénita; no se encontraron diferencias en la longitud de la vía biliar relacionada con la edad. CONCLUSIONES: La UBPA es una malformación que se encuentra presente en población pediátrica occidental con prevalencia y morbilidad desconocida; se requieren estudios a mayor escala para identificar morbimortalidad y prevalencia de pacientes con esta malformación


OVERVIEW: Pancreaticobiliary maljunction (PBM) is a congenital malformation characterized by a long common pancreaticobiliary channel which causes sphincter of Oddi malfunction. In children, it is typically diagnosed using magnetic resonance cholangiopancreatography (MRCP). It is associated with congenital biliary dilatation, pancreatitis, and gallbladder and bile duct tumors at adulthood. Studies in the western population are rare. Given its morbidity rate, it should be searched for in the western pediatric population. The objective of this study was to look for and identify the presence of pancreaticobiliary maljunction through MRCP in pediatric patients with biliary or pancreatic disease, as well as to find out other associated factors. METHODS: MRCP was used to measure common channel length, pancreatic duct length, and bile duct diameter in 41 pediatric patients with biliary or pancreatic disease. RESULTS: The common channel could only be measured in 17.6% of cases, 50% of which were > 8 mm long. All patients were female and had congenital biliary dilatation. No age-related differences were found in terms of bile duct length. CONCLUSIONS: PBM is present in the western pediatric population, but prevalence and morbidity are unknown. Larger studies are required to identify morbidity and mortality, as well as prevalence among patients


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Ductos Pancreáticos/anormalidades , Ductos Pancreáticos/cirurgia , Ducto Colédoco/cirurgia , Colangiopancreatografia por Ressonância Magnética/métodos , Ducto Colédoco/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Colômbia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos
5.
Chirurgia (Bucur) ; 115(4): 526-529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876027

RESUMO

Surgical clip migration in the common bile duct with consecutive stone formation is a rare occurrence after laparoscopic cholecystectomy, less than 100 cases being reported so far. We report a case of a 55-year-old woman with obstructive jaundice due to bile duct stone formed around a migrated surgical clip 9 years after laparoscopic cholecystectomy. The patient presented with pain in the upper abdomen and jaundice. Abdominal ultrasound diagnosed dilation of the common bile duct and intrahepatic bile ducts. The diagnosis was confirmed by computed tomography which revealed a metal clip in the distal part of the common bile duct. The patient was managed successfully by endoscopic retrograde cholangiopancreatography (ERCP) and the surgical clip was retrieved using the Dormia basket. The exact mechanism of clip migration is not fully understood but may be explained by local inflammation and ineffective clipping. Although a rare occurrence, clip migration should not be excluded when considering the differential diagnosis of patients presenting with obstructive jaundice or cholangitis after laparoscopic cholecystectomy. Minimally invasive management by ERCP is the procedure of choice for migrated clips related complications but surgical common bile duct exploration may be necessary.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/etiologia , Ducto Colédoco/cirurgia , Migração de Corpo Estranho/etiologia , Icterícia Obstrutiva/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/instrumentação , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Ducto Colédoco/diagnóstico por imagem , Remoção de Dispositivo , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Icterícia Obstrutiva/diagnóstico por imagem , Icterícia Obstrutiva/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
7.
J Laparoendosc Adv Surg Tech A ; 30(5): 586-589, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32301652

RESUMO

Background: Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy and carries an incidence of 0.3%-0.7%. Recently indocyanine green (ICG) fluorescent cholangiography (FC) has been used as an adjunct to identify the biliary tract during adult laparoscopic cholecystectomy, allowing intraoperative identification of biliary anatomy. The objective of this article is to show its successful use in pediatric laparoscopic cholecystectomies. Method: From July 1, 2017, to November 30, 2018, surgeons at John R. Oishei Children's Hospital and Women and Children's Hospital of Buffalo have been utilizing ICG-FC as an adjunct in patients undergoing laparoscopic cholecystectomy. Thirty-one patients undergoing laparoscopic cholecystectomy had 1 mL of dilute ICG (2.5 mg) injected intravenously in the operating room (OR) before trocar placement. Demographics, intraoperative details, and subjective surgeon data were recorded for elective laparoscopic cholecystectomy cases involving ICG. We hypothesize that use of ICG-FC in the pediatric and adolescent patient population is a safe, reliable, and reproducible adjunct for identification of the biliary tree. Secondary outcomes were to identify rate of biliary anatomy identification, utilization ease, and operative times while using ICG technology in pediatric patients. Results: ICG-FC was used in 31 pediatric laparoscopic cholecystectomies performed by 5 surgeons at our institution. Ages ranged from 6 to 18 years. In all cases, the cystic duct-CBD junction was visualized while performing dissection of the triangle of Calot. No intraoperative complications occurred. Conclusions: ICG-FC provides a noninvasive real-time visualization of the extrahepatic biliary tree in children and adolescents. We demonstrate that ICG-FC can successfully be used as an adjunct in pediatric patients and has the potential to facilitate with the dissection and minimize risk of bile duct injuries during pediatric laparoscopic cholecystectomies.


Assuntos
Doenças dos Ductos Biliares/cirurgia , Colangiografia , Colecistectomia Laparoscópica , Adolescente , Ductos Biliares Extra-Hepáticos/cirurgia , Sistema Biliar/diagnóstico por imagem , Criança , Corantes/farmacologia , Ducto Colédoco/diagnóstico por imagem , Dissecação , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Verde de Indocianina/farmacologia , Complicações Intraoperatórias , Masculino , Duração da Cirurgia
8.
Pediatr Surg Int ; 36(5): 643-648, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32219559

RESUMO

OBJECTIVE: To explore the clinical value of enhanced recovery after surgery (ERAS) with laparoscopic choledochal cyst (CDC) excision in children. METHODS: A retrospective review was performed on the clinical data from 33 in-patients whose final diagnosis was CDC. We included 18 patients who underwent the traditional treatment for CDC from April 2017 to October 2017 as the control group and 15 patients who underwent the enhanced recovery protocol (ERP) from November 2017 to May 2018 as the ERAS group. All the patients had received three-dimensional (3D) laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy by the same group of pediatric surgeons. The time of initial water intake, postoperative time to total enteral nutrition (TEN), postoperative hospital stay, total cost in hospital, postoperative complications, and readmission rate within 30 days were analysed. RESULTS: The postoperative time of initial water intake, postoperative time to TEN, postoperative hospital stay, and total cost in hospital were (21.5 ± 2.1) h, (4.3 ± 0.5) days, (5.3 ± 0.6) days, and (35,945.49 ± 6071.46) China Yuan (CNY) in the ERAS group and (44.1 ± 3.5) h, (7.7 ± 2) days, (9.1 ± 2.5) days, and (45,609.08 ± 11,439.80) CNY in the control group, respectively. These values in the ERAS group were significantly lower than those in the control group (p < 0.05). There was no significant difference between the two groups in terms of postoperative complications. No readmission patient within 30 days was encountered in either of the two groups. CONCLUSION: Enhanced recovery protocols can shorten postoperative hospital stay, relieve perioperative discomfort, lighten the financial burden, and result in substantial improvements.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Ducto Colédoco/cirurgia , Recuperação Pós-Cirúrgica Melhorada , Imageamento Tridimensional/métodos , Laparoscopia/métodos , Anastomose Cirúrgica , Cisto do Colédoco/diagnóstico , Ducto Colédoco/diagnóstico por imagem , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Readmissão do Paciente , Complicações Pós-Operatórias , Estudos Retrospectivos
16.
Tissue Eng Regen Med ; 16(6): 653-665, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31824827

RESUMO

Background: With the popularity of laparoscopic cholecystectomy, common bile duct injury has been reported more frequently. There is no perfect method for repairing porcine biliary segmental defects. Methods: After the decellularization of human arterial blood vessels, the cells were cultured with GFP+ (carry green fluorescent protein) porcine bile duct epithelial cells. The growth and proliferation of porcine bile duct epithelial cells on the human acellular arterial matrix (HAAM) were observed by hematoxylin-eosin (HE) staining, electron microscopy, and immunofluorescence. Then, the recellularized human acellular arterial matrix (RHAAM) was used to repair biliary segmental defects in the pig. The feasibility of it was detected by magnetic resonance cholangiopancreatography, liver function and blood routine changes, HE staining, immunofluorescence, real-time quantitative PCR (RT-qPCR), and western blot. Results: After 4 weeks (w) of co-culture of HAAM and GFP+ porcine bile duct epithelial cells, GFP+ porcine bile duct epithelial cells grew stably, proliferated, and fused on HAAM. Bile was successfully drained into the duodenum without bile leakage or biliary obstruction. Immunofluorescence detection showed that GFP-positive bile duct cells could still be detected after GFP-containing bile duct cells were implanted into the acellular arterial matrix for 8 w. The implanted bile duct cells can successfully resist bile invasion and protect the acellular arterial matrix until the newborn bile duct is formed. Conclusion: The RHAAM can be used to repair biliary segmental defects in pigs, which provides a new idea for the clinical treatment of common bile duct injury.


Assuntos
Artérias/citologia , Células Epiteliais/citologia , Animais , Artérias/metabolismo , Artérias/transplante , Doenças dos Ductos Biliares/terapia , Ductos Biliares/citologia , Colangiopancreatografia por Ressonância Magnética , Técnicas de Cocultura , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/patologia , Células Epiteliais/metabolismo , Células Epiteliais/transplante , Humanos , Queratina-7/metabolismo , Testes de Função Hepática , Suínos
17.
BJS Open ; 3(6): 785-792, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31832585

RESUMO

Background: Todani type 1 and 4 choledochal cysts are associated with a risk of developing cholangiocarcinoma. Resection is usually recommended, but data for asymptomatic Western adults are sparse. The aim of this study was to investigate diagnostic interpretation and attitudes towards resection of bile ducts for choledochal cysts in this subgroup of patients across northern European centres. Methods: Thirty hepatopancreatobiliary centres were provided with magnetic resonance cholangiopancreatograms and asked to discuss the management of six cases: asymptomatic non-Asian women, aged 30 or 60 years, with variable common bile duct (CBD) dilatations and different risk factors in the setting of a multidisciplinary team (MDT). The Fleiss κ value was calculated to estimate overall inter-rater agreement. Results: For all case scenarios combined, 83·3 and 86·7 per cent recommended resection for a CBD of 20 and 26 mm respectively, compared with 19·4 per cent for a CBD of 13 mm (P < 0·001). For patients aged 30 and 60 years, resection was recommended in 68·5 and 57·8 per cent respectively (P = 0·010). There was a trend towards recommending resection in the presence of a common channel, most pronounced in the 60-year-old patient. High amylase levels in the CBD aspirate led to recommendations to resect, but only for the 13-mm CBD dilatation. There were no differences related to centre size or region. MDT discussion was associated with recommendations to resect. Inter-rater agreement was 73·3 per cent (κ = 0·43, 95 per cent c.i. 0·38 to 0·48). Conclusion: The inter-rater agreement to resect was intermediate, and the recommendation was dependent mainly on the diameter of the CBD dilatation.


Assuntos
Colecistectomia/estatística & dados numéricos , Cisto do Colédoco/cirurgia , Tomada de Decisão Clínica , Ducto Colédoco/diagnóstico por imagem , Cirurgiões/psicologia , Adulto , Fatores Etários , Doenças Assintomáticas/terapia , Neoplasias dos Ductos Biliares/etiologia , Neoplasias dos Ductos Biliares/prevenção & controle , Colangiocarcinoma/etiologia , Colangiocarcinoma/prevenção & controle , Colangiopancreatografia por Ressonância Magnética , Colecistectomia/psicologia , Cisto do Colédoco/complicações , Cisto do Colédoco/diagnóstico , Ducto Colédoco/anormalidades , Ducto Colédoco/cirurgia , Europa (Continente) , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
18.
Surg Laparosc Endosc Percutan Tech ; 29(6): 503-508, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31800398

RESUMO

PURPOSE: Few authors have studied applying the laparoscopic approach in patients with previous upper abdominal operations, but no comparison has been made between laparoscopic and open approaches in patients with previous upper abdominal operations. This article aims to introduce surgical techniques and details in treatment to surgeons specialized in minimally invasive surgery. MATERIALS AND METHODS: From January 2010 to January 2018, 460 eligible patients were divided into 3 groups and analyzed retrospectively. Group A: patients with a history of upper abdominal operations who underwent laparoscopy (n=124); group B: patients without a history of upper abdominal operations who underwent laparoscopy (n=140); and group C: patients with a history of upper abdominal operations who underwent an open operation (n=196). Group A was the experimental group; groups B and C served as the control groups. RESULTS: No significant difference was found between groups A and B. Significant differences were found between groups A and C in estimated blood loss (258.3±67.2 vs. 424.7±103.7 mL, P<0.001), postoperative hospitalization (5.7±2.3 vs. 10.2±3.1 d, P<0.001), and postoperative complications (16.1% vs. 42.9%, P=0.013). The final rate of stones clearance was 100% in 3 groups. The total rate of stone recurrence was 7.8%. CONCLUSIONS: Laparoscopy with certain surgical techniques was feasible, effective, and advantageous for patients with previous upper abdominal operations by experienced surgeons. It is necessary for surgeons to have advanced skills and surgical techniques to achieve a successful laparoscopy.


Assuntos
Abdome/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/métodos , Ducto Colédoco/cirurgia , Cálculos Biliares/cirurgia , Ducto Colédoco/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Seguimentos , Cálculos Biliares/diagnóstico , Humanos , Laparoscopia , Laparotomia , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
19.
BMC Gastroenterol ; 19(1): 177, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699035

RESUMO

BACKGROUND: Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered in the differential diagnosis for patients presenting with typical symptoms even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review may offer some help when dealing with choledocholithiasis caused by foreign bodies. CASE PRESENTATION: We reported a case of choledocholithiasis caused by fishbone from choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by foreign bodies published until June 2018 and wrote the world's first literature review of foreign bodies in the bile duct of 144 cases. The findings from this case suggest that the migration of fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of choledocholithiasis. CONCLUSION: The literature review declared the choledocholithiasis caused by foreign bodies prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of choice. It is a very singular case of choledocholithiasis caused by fishbone, and the present review is the first one concerning choledocholithiasis caused by foreign bodies all over the world.


Assuntos
Coledocolitíase , Ducto Colédoco , Corpos Estranhos , Migração de Corpo Estranho , Laparoscopia/métodos , Idoso , Coledocolitíase/sangue , Coledocolitíase/diagnóstico , Coledocolitíase/etiologia , Coledocolitíase/cirurgia , Coledocostomia/efeitos adversos , Coledocostomia/métodos , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
20.
World J Surg Oncol ; 17(1): 191, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711502

RESUMO

BACKGROUND: Biliary intraepithelial neoplasia (BilIN) is often distinguished by what it is not: the precancerous lesions are not mass-forming, are not the cause of bile duct obstruction, and are small enough (less than 5 mm long) to evade detection by the naked eye. Here, we describe an atypical case of BilIN resembling cholangiocarcinoma (CC) that was large enough to be identified by diagnostic imaging and presented with obstructive jaundice caused by a hematoma in the common bile duct (CBD). CASE PRESENTATION: A 64-year-old man presented to our hospital with upper abdominal pain and anorexia. Initial laboratory examinations revealed increased total bilirubin and a computed tomography (CT) scan revealed a dilated CBD. Gastroenterologists performed an endoscopic sphincterotomy (EST), which revealed that the cause of obstructive jaundice was a hematoma in the CBD. Enhanced CT scan and magnetic resonance cholangiopancreatography (MRCP) performed after the hematoma was drained showed improved dilation of the CBD and an enhanced wall thickness of bile duct measuring 25 × 10 mm at the union of the cystic and common hepatic ducts. A cholangioscope detected an elevated tumor covered by sludge in the CBD, and we performed an extrahepatic bile duct resection and cholecystectomy. The postoperative course was uneventful and the pathological examination of the resected tumor revealed that although the ulcerated lesion had inflammatory granulation tissue, it did not contain the components of invasive carcinoma. Many consecutive intraepithelial micropapillary lesions spread around the ulcerated lesion, and the epithelial cells showed an increased nucleus-to-cytoplasm ratio, nuclear hyperchromasia, and architectural atypia. The pathological diagnosis was BilIN-1 to -2. Immunohistochemical staining showed that S100P was slightly expressed and MUC5AC was positive, while MUC1 was negative and p53 was not overexpressed. CONCLUSION: We experienced an atypical case of BilIN mimicking CC that presented with obstructive jaundice caused by a hematoma in the CBD. Our case suggested that the occurrence of BilIN can be triggered by factors other than inflammation, and can grow to a size large enough to be detected by image analyses.


Assuntos
Dor Abdominal/etiologia , Ducto Colédoco/patologia , Epitélio/patologia , Hematoma/etiologia , Icterícia Obstrutiva/etiologia , Idoso , Neoplasias dos Ductos Biliares/diagnóstico , Colangiocarcinoma/diagnóstico , Colangiopancreatografia por Ressonância Magnética , Colecistectomia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Diagnóstico Diferencial , Humanos , Icterícia Obstrutiva/cirurgia , Masculino , Prognóstico , Esfinterotomia Endoscópica , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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