Intrinsic common bile duct stricture: an unusual presentation of retroperitoneal fibrosis

Abstract

Retroperitoneal fibrosis is a rare disorder characterized by the presence of dense, grayish-white plaques centered about the abdominal aorta in the retroperitoneal space.1,2 Most commonly, it causes fibrous encasement of the ureters and subsequent obstructive uropathy leading to renal failure. Atypical sites of involvement include the small intestine, mesentery, duodenum, colon, urinary bladder, and epidural space.1 Typically, mass effect from the enlarging fibrous plaque leads to compromise of surrounding structures. For example, extrinsic compression can lead to small and large bowel obstruction, vena caval stasis, and arterial insufficiency in the lower extremities.1,3 The disease has an incidence of 1 in 200,000 and predominantly affects men, with a male to female gender ratio of 2-3 to 1.1,3 It generally presents in the fifth to sixth decades of life with dull noncolicky flank and back pain, weight loss, nausea, vomiting, malaise, hypertension and fever.1,3 Involvement of the common bile duct in this rare disorder is extremely uncommon. In this report we describe an unusual case of retroperitoneal fibrosis presenting with a malignant-appearing common bile duct stricture without a contiguous soft tissue mass or adenopathy on imaging studies.