Ictericia obstructiva por molde biliar debido a cuerpo extraño

Abstract

We present a case of a 59 year old woman who was admitted to hospital in October 2009 for jaundice, abdominal pain, vomiting and fever of 38.5 o C, for one month of evolution. She reported a history of cholecystectomy because of multiple cholelithiasis and choledochotomy for removal of intracoledocal stones 24 years ago. The bile duct was closed on nylon tubing Kher 4 / 0 non-absorbable. Among the analytical data stood out: bilirubin, 3.9 mg / dl; ALP, 525 U / L (40-129); GGTP, 1313 U / L (8-61); GOT, 377 U / L (6-38); GPT, 909 U / L (6-41); lipase, 95 U / L (0-60) and ESR, 53 mm / h. An abdomen ultrasound showed moderate dilatation of the main bile duct. Cholangiography was performed which revealed a common bile duct 13 mm in diameter with a tubular image of 30 x 5 mm inside that has a hyperintense core and leaving no acoustic shadow (Fig. 1). ERCPwas made that aimed an intracoledocal filling defect of 30 x 5 mm (Fig. 2). After sphincterotomy, we passed the Fogarty ball and extracted several microstones. Then the cystic duct was channeled and passed the ball again without obtaining material. For the second time, the bile duct was cannulated and introduced the Dormia basket. An elongate, oblong, 3 cm in length biliary mold was extracted (Fig. 3). The pathology report corresponded to the suture with biliary debris. Obstructive jaundice for biliary mold due to foreign body