Abstract
We present the case of an 86-year-old man who had undergone left nephrectomy for renal cell carcinoma (clear cell carcinoma) 22 years ago. He visited the emergency department complaining of right hypochondrial pain and fever. He was eventually diagnosed with acute cholangitis. Abdominal contrast-enhanced computed tomography showed multiple tumors in the pancreas. The tumor in the pancreatic head obstructed the distal bile duct. Endoscopic retrograde cholangiopancreatography detected bloody bile juice flowing from the papilla of Vater. Therefore, he was diagnosed with hemobilia. Cholangiography showed extrinsic compression of the distal bile duct; a 6 Fr endoscopic nasobiliary drainage tube was placed. Endoscopic ultrasound showed that the pancreas contained multiple well-defined hypoechoic masses. Endoscopic ultrasound-guided fine-needle aspiration was performed using a 22 G needle. Pathological examination revealed clear cell carcinoma, and the final diagnosis was pancreatic metastasis of renal cell carcinoma (RCC) causing hemobilia. A partially covered metallic stent was placed in the distal bile duct. Consequently, hemobilia and cholangitis were resolved.
Highlights
Renal cell carcinoma (RCC) may recur even after a long period of time has passed from radical resection
We report a case of pancreatic metastasis of RCC that caused hemobilia 22 years after surgery; hemostasis was achieved by applying a covered-type self-expandable metallic stent (SEMS)
Nephrectomy was performed for left renal tumor 22 years ago, and the patient was pathologically diagnosed with clear cell carcinoma
Summary
Renal cell carcinoma (RCC) may recur even after a long period of time has passed from radical resection. Cholangiography via the endoscopic naso-biliary drainage revealed that the distal bile duct was extrinsically compressed by the tumor (Fig. 4). Surgical and pathological reports of surgical resection of RCC 22 years ago were not available, but based on the clinical images and pathological findings of EUS-FNA, the patient was diagnosed with multiple pancreatic metastases from RCC. Another ERCP was performed, and a partially covered SEMS with 10 mm diameter and 80 mm length (WallFlexTM Biliary RX Stent, Boston Scientific Japan, Tokyo, Japan) was placed after small-incision endoscopic sphincterotomy (Fig. 6). Since the stent was placed, no SEMS migration has
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
