Part Of Duodenum Research Articles

Diagnostic Yield of Routine Duodenal Biopsies in Iron Deficiency Anemia for Celiac Disease Diagnosis

Background. Iron deficiency anemia (IDA) is a recognised feature of celiac disease (CD) in adults and can be its only presentation. Aim. To define the prevalence of CD in Moroccan adult patients with IDA of obscure origin and to determine the yield of small bowel biopsy performed during routine endoscopy. Methods. 437 patients with IDA of obscure origin were included. 4 endoscopic mucosal biopsies were taken from the second part of duodenum and 2 biopsies from antrum and fundus, respectively. Endoscopic aspect and severity of anemia were correlated with histological diagnoses using coefficient Kappa. Results. 29 out of 437 patients (6.63%) had CD. Endoscopic aspect was normal in 66%, a mosaic pattern of mucosa in 17%, and scalloping of the small bowel folds in 17%. 12 patients had Marsh III, 8 had Marsh II, 6 had Marsh I, and 3 had Marsh IV lesions. There was no correlation between degree of anemia, endoscopic aspect, and severity of duodenal lesions . Conclusion. Routine duodenal biopsy gives an additional 6.63% diagnostic benefit of CD and should be indicated in all patients with IDA. The finding of normal endoscopic appearance of mucosa should not preclude duodenal biopsies.

Villous Adenoma of Duodenum: A Rare Case Presentation with Review of Literature

In the year 2008, a 42 years old female presented to the medical outpatient with complaints of dyspepsia for 3 months with mild vague pain abdomen off and on. Her bowel and bladder habits were normal. She had no other associated comorbidity. She had no history of jaundice, malaena or haematemesis. There was no significant family history or past history. On clinical examination, she had moderate pallor and rest of the general and systemic examination was normal. Her routine blood investigations showed Hb% of 7.5 gm% and serum electrolyte, creatinine and LFT were within normal limits. She was advised ultrasound abdomen which was normal. Thereafter she was planned for Upper Gastrointestinal Endoscopy which was done and revealed a cauliflower like growth in the second part of the duodenum with stomach and esophagus being normal. Endoscopic biopsy was done which was reported as adenomatous polyp with no evidence of malignancy. CECT abdomen was done which showed duodenal growth with ? pancreatic head invasion and ampullary region was spared. Patient was planned for exploratory laparotomy, frozen section and proceed. After two units of blood tansfusion for her anaemia, exploratory laparotomy was done and a growth was felt in second part of duodenum which was soft to firm in consistency. A dimpling was noted on the anterior wall of the second part of the duodenum and a small paraduodenal node found anterior to duodenum. Rest of the abdominal structures were normal. Duodenotomy was done and excision of the duodenal polyp, which was about 5.5×5×2.5 cms, cauliflower like in appearance, was done. The ampulla was found to be normal. Frozen section was sent which was suggestive of adenomatous polyp with mild to moderate dysplastic changes and no evidence of malignancy and reactive lymphadenitis in the paraduodenal node hence, duodenoplasty performed and an abdominal drain kept in right subhepatic space and abdomen closed (Figs. 1 and 2). Post-operative period was uneventful and the patient was discharged in good health on the tenth post-operative day. Final biopsy was of Villous adenoma of the duodenum. A repeat UGIE was done at 6 months and 1 year and then annually for 3 years and was found to be normal. In view of the high association of duodenal and colonic polyps, the patient was also advised colonoscopy, but did not agree. At present she is in follow-up and asymptomatic with good quality of life after 3 years follow-up (Figs. 3, 4 and 5).

Variations in Superior Pancreaticoduodenal Artery -A case report

The superior pancreaticoduodenal artery typically arises as the first branch of gastroduodenal artery, above the upper border of the head of the pancrease, and passes either above or behind the first part of duodenum. During the routine dissection in the department of Anatomy, This rare variation of superior pancreaticoduodenal artery was noticed in a male cadaver of approximately 50 years of age. In this case the superior pancreaticoduodenal artery showed variation in its branching pattern. The artery appeared more tortuous, wide and long. More details in this regard and clinical aspects will be discussed.

Immunological monitoring after pancreas transplantation

After switching from bladder to enteric drainage, pancreas graft monitoring, particularly after solitary transplantation, has become an important issue. The aim of this work was to systematically review the relevant literature with regard to various biomarkers, imaging techniques, and pathologic evaluation of allograft tissue. More recent studies including graft histology demonstrate the low specificity of pancreatic enzymes as a marker of acute rejection. On the other hand, most blood and serum markers are indicative of an activated immune status rather than rejection. Interestingly, the concomitantly transplanted kidney from the same donor does not seem to be a reliable surrogate marker. Although computed tomography or ultrasound-guided percutaneous biopsies of the pancreas are performed more frequently at present, the complication rate is still as high as 11%. In contrast, cystoscopic and enteroscopic biopsies of the duodenal part of the graft are associated with almost no complications. The few clinical studies dealing with the duodenum as surrogate marker for the pancreas report a high correlation between duodenum mucosal and pancreas parenchymal histology. Pancreatic graft parenchymal biopsy remains the gold standard in diagnosing pancreatic rejection, as clinical parameters, pancreatic enzymes, noninvasive biomarkers, and surrogate renal biopsies are not reliable tools. Endoscopically obtained duodenal cuff biopsies are a less invasive alternative to percutaneous biopsies.

Modified Grahams′ omentopexy in acute perforation of first part of duodenum; A tertiary level experience in South India

Background: Despite the rarity (5%) of acute perforation of first part of duodenum (D1) and the advancement in surgical, anesthetic and ancillary facilities, still there are life-threatening dimensions. A variety of surgical techniques evolved over time, but none is without drawbacks. Thus, the need arise for surgeon friendly, suitable surgical technique with better outcome. By this retrospective analysis, we aimed to compare between the Graham's omentopexy (GO) and modified Grahams' omentopexy (MGO) to find the suitable method of managing this acute catastrophe. Materials and Methods: This is a retrospective study design for the period June 2009-May 2012. All the patients with only D1 perforation admitted and treated at our institution were included. Patients with perforation other than D1 site, multiple perforations, poly-trauma and associated co-morbidity were excluded. Patients were randomly subjected for either GO or MGO. Post-operatively, all were followed-up for 3 months at out-patients department. Results: Out of the 122 patients, 112 were males and 10 were females with M:F ratio 11.2:1. MGO group had comparatively less chances of biliary fistula, burst abdomen and mortality, but, more chances of wound infections with longer hospital stay and better outcome at 3 month follow-up in contrast to GO group. The overall mortality rate was 4.09%. Conclusion: MGO is surgically suitable technique than GO for patients with D1 perforation with better post-surgical outcome.

Hem-o-Lok Clip in the First Part of Duodenum after Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy (LC) and common bile duct exploration (LCBDE) have become the standard surgical procedure for cholecystolithiasis and choledocholithiasis. During the operation, cystic duct and vessels are usually controlled by Hem-o-Lok clips. We report a case with a complaint of severe abdominal pain for the previous 20 days. Her medical history was unremarkable except for laparoscopic cholecystectomy 8 months ago. In upper gastrointestinal endoscopy, two Hem-o-Lok clips at anterior wall of the first part of duodenum were detected. Therefore, the clip can migrate during postoperative period and Hem-o-Lok is not a very safe ligation method during laparoscopic cholecystectomy.

ADENOCARCINOMA OF DUODENUM AT THE DUODENOJEJUNAL FLEXURE

ADENOCARCINOMA OF DUODENUM AT THE DUODENOJEJUNAL FLEXURE (Abstract): Adenocarcinoma of the duodenum is an exceedingly rare condition representing not more than 0.3% to 0.4% of all gastrointestinal tract cancers. Clinical presentation is usually due to partial or complete obstruction of the duodenum. Computed tomography scan has a high accuracy in detecting metastatic spread to stage the disease. CASE REPORT: A 60 year woman presented with chief complaints of persistent bilious projectile vomiting containing undigested food material and pain in the upper abdomen since 6 months. Upper gastrointestinal endoscopy up to 2 nd part of duodenum revealed no abnormality. Contrast enhanced computed tomography (CECT) scan of abdomen showed a dilated stomach and duodenal dilatation up to 4 th part along with a concentric growth seen in the fourth part of duodenum at the duodenojejunal flexure, and multiple retroperitoneal lymph-adenopathy. Exploratory laparotomy revealed a tumor of the duodenojejunal flexure with dilatation of all the parts of duodenum and stomach. The tumor was seen encasing the superior mesenteric vessels and aorta. A palliative gastro-jejunostomy was performed. Patient had an attack of acute myocardial infarction on post-operative day 6th and expired. Histopathology of the specimen confirmed adenocarcinoma of duodenum. CONCLUSIONS: Adenocarcinoma of duodenojejunal flexure is extremely rare and sometimes difficult to diagnose. Computed tomography scan has a high accuracy in detecting the disease and its metastatic spread to stage the disease. For unresectable tumors, palliative gastro-jejunostomy is the treatment of choice.

An adolescent girl with Rapunzel syndrome: Case report with review of literature

Trichobezoar is a collection of dense mass of hair in stomach. When this extends into any part of the small intestine it is called Rapunzel Syndrome (RS). We report here, a case of RS in an adolescent girl who had presented with epigastric pain and swelling. Gastroscopy confirmed the presence of trichobezoar. She underwent gastrotomy and a large dense mass of hair extending up to first part of duodenum was removed. Her parents revealed their daughter's impulsive nature of scalp-hair pulling. Following surgery, Psychiatric consultation was sought to prevent recurrence. Trichobezoar is a very rare cause of upper abdominal mass and should be considered if there is a very strong history of impulsive hair pulling. Surgical removal of a large trichobezoar is the only treatment of cure and psychiatric treatment that prevents its recurrence.

Recent trends in peptic perforation

Introduction: The peptic perforation is one of the commonest abdominal surgical emergencies. Common causes are H.pylori, increased inadvertent use of NSAIDS, smoking and stress of modern life. During last few years there has been great revolution in availability of the newer broad spectrum antibiotics, better understanding of disease, effective resuscitation, prompt surgery under modern anaesthesia techniques, and intensive care unit resulted in reducing the mortality. Materials and methods: This prospective study was carried out in the department of surgery during period from 1st May 2009 to 30th November 2011. All were indoor patients with diagnosis of peptic perforation in stomach and/or duodenum excluding other sites. Each patient was study in detail with relevant clinical history, examination, laboratory investigations and management. The study comprised of total 50 patients operated for peptic perforation by various modalities. Results: the middle age group was commonest. Smoking, alcohol and stress were common etiological factors. The perforation was common in anterior surface of the first part of duodenum. Wound infection and bronchopneumonia were common post-operative complications. Discussion: The duration of perforation more than 24 hours and size of the perforation more than 1 cm has increase morbidity & mortality. Early diagnosis and prompt management of shock & septicaemia is important for better prognosis of patients. The simple closure with omentopexy of peptic perforation still remains the first choice as a treatment. H-pylori eradication treatment is mandatory after simple closure of the perforation to prevent recurrence of ulcer.

Endoscopic Banding for Duodenal Carcinoid Tumors

Introduction: Carcinoids of the duodenum are rare and have an indolent course. Most of these patients have been conventionally subjected to extensive surgery based on the site of the tumor. In this report, we have explored the safety and feasibility of endoscopic banding for such tumors. This to our best knowledge is only the second such report in English medical literature. Case report: In a 50-year-old woman with history of abdominal pain and vomiting, upper gastrointestinal endoscopy revealed a 0.5 cm umbilicated nodular lesion along the medial wall of the first part of duodenum. Biopsy of the lesion confirmed it to be a carcinoid, and endoscopic ultrasonography (EUS) showed the carcinoid was confined to the submucosa. Endoscopic banding with resection of the lesion was done. Patient tolerated the procedure well and is asymptomatic on follow-up. Conclusion: Small duodenal carcinoids confined to the submucosa can be safely and effectively managed by endoscopic banding and preoperative. Larger studies in patients with duodenal carcinoids tumors are needed to confirm these promising results.

A Rare Case of Exophytic Duodenal Stromal Tumor: Case Report

Gastrointestinal stromal tumors(GIST) have become a well established entity and its taxonomy is no more ambiguous but GIST of duodenum is rarely seen .In this paper , a patient presented with only recurrent pain abdomen and USG/CECT of abdomen revealed gallstone with 8x7x4.7 cm size mass lesion in the right hypochondrium, most likely arising from the second part of duodenum. The patient underwent cholecystectomy and wedge resection of tumor. The histopathology of the mass confirmed the diagnosis of duodenal stromal tumor.

Duodenal Tuberculosis – A Rare Case Report and Review of Literature

Extrapulmonary tuberculosis is rare and often difficult to diagnose infection. We report a case of duodenal tuberculosis, who presented with upper gastrointestinal symptoms. There was evidence of obstruction in the third part of duodenum (D3) on oesophagogastro endoscopy, barium meal follow through and CT scan of abdomen. On exploration there was thickening of D3 and D4 causing luminal obstruction. Resection of stricturous segment with end-to-side duodenojejunostomy was done. Biopsy of the diseased segment was tubercular. Antitubercular treatment was given to the patient for 6 months and he is doing well on follow up (1 year after surgery). Duodenal tuberculosis being the rarest form of intestinal tuberculosis poses great difficulty in diagnosis. High index of suspicion supported by radiological investigation, exploratory laparotomy and histopathological examination of the tissue can only lead to a definitive diagnosis of this rare condition. Treatment is both surgical which involves resection or by-pass for an obstructive lesion and medical which includes antitubercular therapy.

18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging of extra-medullary plasmacytoma of the ovary

Extrameduallary plasmacytoma of ovary is extremely rare. We report a case of involvement of ovary in a treated case of plasmacytoma of 2nd part of duodenum, which was initially thought to be physiological luteal activity. However, follow up whole body FDG PET-CT scan shows appearance of metabolically active soft tissue mass in left adnexal region which confirmed to be extra-medullary plasmacytoma of ovary on histopathology.

Superior mesenteric artery syndrome: A rare case of bowel obstruction in schizophrenic patient

Introduction: superior mesenteric artery syndrome is a rare condition of obstruction to the third part of duodenum. Identification of this syndrome is challenging and is frequently made by a process of exclusion. case report: We report the first case of superior mesenteric artery syndrome in a severely cachectic schizophrenic patient with paranoid delusions who presented with features of proximal gastrointestinal obstruction. the

Effect of different single feeding diets on small intestinal mucosa of cocks: a histomorphometrical study

Diet composition as a major factor can affect histological status of the gut. The present study was conducted to evaluate histological changes of small intestinal wall of cockerels fed with high protein, high carbohydrate, or high fiber single diets. To this end, thirty Rhode Island Red cockerels, 70 weeks of age, were randomly allocated into three equal groups and hull-less barley, soybean meal, and sunflower meal supplemented to the basal diet of each group gradually during first week. Birds were fed with 100 % of each of the above diets for the next 2 weeks. At the end of the third week, all birds were sacrificed and small intestines were removed immediately and processed for histological study. Transverse sections from the middle parts of duodenum, jejunum, and ileum were made and stained with H&E and PAS for light microscopic study. Villus height, villus width, crypt depth, villus height/crypt depth ratio, and goblet cell number per unit area were determined. Data were analyzed by one-way ANOVA method. While hull-less barley and soy bean meal diets had no undesirable effect on histological parameters of small intestine, sunflower meal significantly decreased villus height/crypt dept ratio which may decrease nutrient absorption. In conclusion, single feeding with sunflower meal, but not hull-less barley and soy bean meal diets, adversely affects histological feature of intestinal mucosa of cockerels which may lead to decreased nutrient absorption and subsequently declined performance of the birds.

Multicentric Castleman Disease with Complete Duodenal Obstruction in an HIV Patient

Abstract 4834Multicentric Castleman's Disease(MCD) can have an aggressive course making early diagnosis and treatment important. Although rare, peripancreatic involvement is known in Castleman's disease and an unusual presentation should be considered especially in the setting of HIV. An excisional lymph node biopsy is required for diagnosis. High plasma titers of Human Herpes Virus 8 DNA should also raise this possibility. Coexistence of Castleman disease and body cavity lymphoma has been reported but is rare. Case Presentation:A 42 year old African American gentleman with a history of HIV and CD4 count 271 presented with intractable nausea and vomiting of 1 month duration; associated with epigastric pain and weight loss. Past history was significant for presentation with jaundice 6 months earlier when he was found to have a pancreatic head mass with portocaval and retroperitoneal lymphadenopathy raising the suspicion of pancreatic adenocarcinoma. Endoscopic ultrasound guided fine needle aspiration of the mass had revealed a poorly differentiated malignant neoplasm that could not be further characterized by immunohistochemistry. Considering the HIV status of the patient, there was a strong suspicion of lymphoma. A PET-CT was planned to identify an appropriate site for tissue diagnosis but the patient was lost to follow up. Repeat imaging during the current admission revealed increasing size of the pancreatic mass causing complete obstruction of second part of duodenum. The patient subsequently underwent gastro-jejunostomy to bypass the duodenal obstruction and an excisional biopsy of two mesenteric lymph nodes was performed during the procedure. Pathology revealed HHV-8 positive plasma cell variant of Castleman's disease. Patient also had high plasma titers of HHV-8. Furthermore, the patient was also found to have bilateral pleural effusions and a thoracentesis was performed. Pleural cytology revealed large plasmablastic lymphoid cells that were positive for HHV-8, CD30, CD45, CD138, Ebstein-Barr virus (EBV), epithelial membrane antigen, and multiple myeloma oncogene-1. These findings suggested a diagnosis of body cavity lymphoma. Discussion:Although rare, the association of Multicentric Castleman's disease (MCD) with HIV is well recognized. The incidence is independent of CD4 count and the use of HAART. There are isolated case reports of pancreatic involvement with Castleman's disease and only one involving the duodenum. While most patients with peripancreatic involvement presented with abdominal discomfort, nausea or systemic symptoms, our patient was severely symptomatic from complete duodenal obstruction. Our case also highlights that the diagnosis can be elusive and requires excisional lymph node biopsy. Moreover, HIV MCD is fluorodeoxyglucose avid, and a PET-CT may help identify the gland to biopsy next in difficult to diagnose cases. Body cavity lymphoma is also HHV-8 related and this diagnosis should be considered in any HIV patient with effusions. Pleural fluid cytology and immunohistochemistry usually clinch the diagnosis. Disclosures:No relevant conflicts of interest to declare.

An unusual case of duodenal beaking

A 35-year-old female presented with complaints of several episodes of malaena and frank blood in the stools for the past 1 year. The frequency of these episodes had increased in the past 2 months. The patient complained of extreme weakness and palpitations. There was no history of abdominal pain, nausea, vomiting or haematemesis. There was no history of fever, jaundice, weight loss or constipation. Physical examination was unremarkable except for the presence of severe pallor. Digital rectal examination revealed black tarry stools staining the glove. There was no palpable growth; first degree haemorrhoids were visible at the 3 o'clock position; no active bleeding was discernible. Her haemoglobin was 4 g dl−1, packed cell volume 12.5%, total leukocyte count 7900 cells mm−3and platelet count 5.34×105 mm−3. Peripheral smear showed features of anaemia. Total serum bilirubin was 2.5 mg dl−1 (direct bilirubin 1.2 mg dl−1). The rest of the liver function tests were within normal limits. HBsAg (the surface antigen of the hepatitis B virus) was negative and human immunodeficiency virus was non-reactive. A chest radiograph demonstrated mild cardiomegaly and the lung fields were clear. Colonoscopy was within normal limits. An upper gastrointenstinal endoscopy was performed, which showed a normal stomach and first part of duodenum. The endoscope could not be negotiated into the third part of the duodenum. A barium meal examination was done for further evaluation of the upper gastrointestinal tract. Two radiographs of an upper gastrointestinal barium series are shown (Figure 1). Figure 1 (a) Barium meal upper gatsrointestinal tract: smooth narrowing or “beaking” at the junction of the second and third parts of the duodenum, with mucosal folds running parallel to the lumen and a small C-loop of the duodenum. (b) Barium ...

Formulation and in vitro absorption analysis of Rhizoma paridis steroidal saponins

Rhizoma paridis steroidal saponins (RPS) have been prepared and identified as the active compounds for antitumor activity in our previous study. However, the low oral bioavailability of the steroidal saponins restricted its using. In the present research, solid dispersion (SD) and phytosome (PHY) formulation of RPS were prepared, and the physicochemical parameters as well as the intestinal absorption in rat everted gut sac model were investigated. Seven agents were selected as the carriers of SD, and poloxamer 407 (P 407) was the most suitable one. SD reduced the particle size of saponins in the water solution, enhanced the solubility of the saponins by about 3.5 folds, and significantly improved the absorption transport of saponins from 48 to 104 μg in everted gut sac of the rat system. PHY significantly enhanced the hydrophilic of saponins but showed little effect on the absorption in small intestine. Jejunum and ileum part absorbed more absolute contents of total saponins than duodenum parts. Six saponins, the main contents of RPS, used as the index of comparing the three forms, were also further investigated in the physico-chemical properties and the absorption tests. n-Octanol/water partition coefficients of the six saponins ordered in RPS, SD and PHY were Chonglouoside H>Dioscin>Polyphyllin D>Gracillin>Paris-VII>Formosanin C. All the saponins possessed the higher absorptive characteristics in SD formulation. The absorption rate of diosgenyl saponins in intestine was more than the pennogenyl saponins.

Complete Radiological Findings in Gallstone Ileus

A 79 year old female causcasian patient with a background history of type II diabetes mellitus, hypertension and hypercholesterolaemia, presented with a 1 day history of bilateral flank and lower abdominal pain and a few episodes of vomiting. Of note, there was no history of constipation or obstipation. Clinical exam on presentation showed no localizing abdominal signs. The patient was also found to be dehydrated and hyperglycaemic. A plain radiograph of the abdomen was performed (Fig. 1A). This demonstrated the 'Rigler Triad' of dilated small bowel loops in the left upper quadrant (arrow), linear lucencies in the right upper quadrant, corresponding to the anatomic location of the liver, suggesting pneumobilia (arrowhead) as well as a partly calcified ovoid density in the left lower quadrant (curved arrow). If these are present, it is considered to be sufficient for diagnosis in the correct clinical scenario.1-3 Esophago-gastro-duodenoscopy was then performed which suggested the presence of a fistula originating from the first/second part of the duodenum and a barium meal was subsequently performed to further confirm the findings of endoscopy and to delineate the anatomy of the fistula (Fig. 1B). A fistulous tract was demonstrated between the junction of the first and second parts of duodenum and the gallbladder neck, with subsequent filling of barium into the proximal common bile duct from the cystic duct as well as the gallbladder body. Figure 1 Abdominal radiograph and barium meal. (A) Abdominal radiograph demonstrating the 'Rigler Triad' of dilated small bowel loops in the left upper quadrant (arrow), linear lucencies in the right upper quadrant, corresponding to the anatomic location of the ... CT of the abdomen and pelvis was subsequently performed which demonstrated an acute small bowel obstruction (blue arrowhead) secondary to an intraluminal obstructing gallstone (blue arrow) in the proximal ileum (Fig. 2). Figure 2 Contrast enhanced CT of the abdomen and pelvis demonstrating acute small intestinal obstruction (blue arrowhead) secondary to an intraluminal obstructing gallstone (blue arrow) in the proximal ileum. The transition point was located in the left hemipelvis, in a location corresponding to the calcified density seen previously on plain radiography. A diagnosis of gallstone ileus was made and the patient was referred to the gastro-intestinal surgeons. The diagnosis was confirmed at laparotomy and an enterolithotomy was performed (Fig. 3). Figure 3 Photograph taken at the laparotomy and enterolithotomy demonstrating the large obstructing gallstone impacted in the distal ileum.

Obstructive Jaundice: The Kidney Can Do It!

Introduction: Obstructive jaundice is a common clinical problem that gastroenterologists encounter. We report a rare case of obstructive jaundice caused by right renal cyst and hydronephrosis due to obstructive proximal ureteric stone. Case: A 69-year-old woman presented with yellowish discoloration of skin and dark urine for 2 days. Patient was a resident at the rehabilitation center after drainage of septic arthritis of left hip. She had history of coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, stroke, dementia and cholecystectomy. On examination she had scleral icterus and mild tenderness in right upper abdominal quadrant. Rest of the examination was unremarkable. Laboratory data on admission was abnormal for total bilirubin 11.1 mg/dL (normal 0.2-1.1), alkaline phosphatase 2,020 IU/L (32-92), AST 207 IU/L (15-41), ALT 171 IU/L (14-54), amylase 700 U/L (24-121), lipase >400 U/L (22-51). A computed tomography (CT) scan of abdomen showed mild common bile duct (CBD) dilatation at 11 mm, cystic structure anterior to the CBD measuring 5.3 × 3.9 cm and 12 mm right proximal ureteric stone with right hydronephrosis and cystic changes within right kidney. Magnetic resonance cholangio-pancreaticography (MRCP) showed no filling defect within biliary tree, enlarged right kidney with multiple cysts and exophytic cyst of 4.4 × 3.3 cm at anterior aspect of right kidney creating a mass effect on second portion of duodenum and pancreatic head. This corresponds to cystic structure seen on CT scan. Urology recommended decompressing cystic structure under radiologic guidance. During course of hospitalization, patient's liver functions started improving before she received any intervention. Upon attempting decompression, her renal cyst appeared to be reduced in size relieving compression on the second part of duodenum with improvement of her liver functions. Patient did not need any procedure. Three months later, her liver functions were within normal limits. With her poor condition, patient denied any further invasive work-up. Discussion: Obstructive jaundice can be caused by extrinsic compression of the biliary system. Extrinsic causes include pancreatic pseudocysts or lymphomas. Renal lesions causing obstruction of the biliary system have been very rarely reported. Giant hydronephrosis and megaureter have been reported to cause obstructive jaundice. We present a rare case of obstructive jaundice caused by right renal cyst with hydronephrosis due to obstructive ureteric stone. Although our case improved spontaneously, drainage procedures should be considered in similar cases.