Rare Cause Of Obstructive Jaundice Research Articles

Extrahepatic bile duct fibroma in an infant: a case report

BackgroundExtrahepatic bile duct tumor in neonates and infants is extremely rare. Fibroma in neonates and infants has been reported in different body parts but not in the bile duct. We report a 2-month-old girl with common bile duct (CBD) fibroma.Case presentationA 2-month-old girl presented with jaundice and pale stool for 15 days. Her perinatal period was uneventful. On examination, we found the girl deeply icteric and having hepatomegaly but no palpable lump. Laboratory investigations revealed direct hyperbilirubinemia with elevated liver enzymes. Ultrasonography revealed hepatomegaly with focal dilatation of the extrahepatic bile duct (2.1 × 0.5 cm). Our preliminary diagnosis was a type I choledochal cyst. Considering the clinical scenario, we planned for exploration without further imaging. On exploration, we found the liver blackish and a hard mass involving the common CBD and cystic duct. The gall bladder was filled with clear mucus. After excising the mass, the gall bladder, and CBD, we reconstructed the anatomy with Roux-N-Y hepaticojejunostomy. The postoperative period was uneventful except for minor bile leakage during the first four postoperative days, which stopped spontaneously. Histopathology revealed spindle-shaped fibrous tissue admixed with collagenous tissue, compatible with a fibroma. A liver biopsy showed the features of cirrhosis. However, liver function tests were normal 2 weeks after surgery. The baby was thriving at 6 months of follow-up, hepatomegaly was resolved, and there was no clinical or radiological sign of recurrence.ConclusionsCBD fibroma is a rare cause of obstructive jaundice in neonates and infants. The earliest possible excision of the tumor and bile drainage restoration are necessary to halt the progression of liver damage.

Successful Treatment of Refractory Inspissated Bile Syndrome Using Gastrografin

AbstractInspissated bile syndrome (IBS) is a rare cause of obstructive jaundice in infants. Despite drainage and irrigation, obstruction may persist in some cases with limited further options. This report presents a case of persistent IBS in a 5-month-old female with worsening liver failure despite cholecystostomy and saline irrigation, and a last-ditch effort was made to irrigate with Gastrografin. Patient's bilirubin decreased from 15.5 to 8.3 mg/dL after 1 day. Her bilirubin and liver functions tests normalized by 2 weeks. Gastrografin's hyperosmolarity promotes intraluminal fluid shift and stimulates smooth muscle contraction, which may explain its effectiveness in treating refractory IBS.

Lemmel syndrome: a rare cause of obstructive jaundice (case report)

Obstructive jaundice through periampullary duodenal diverticulum (PAD), without gallstones or neoplasms, was first described by Lemmel in 1934 as Lemmel syndrome. PAD can be diagnosed incidentally or suspected in patients with obstructive jaundice and nonspecific abdominal pain. It is a rare and benign condition that can be misdiagnosed as malignancy. Ignoring this, can cause morbidity and mortality. Definite diagnosis is made by Endoscopic Retrograde Cholangiopancreatography (ERCP). An accurate diagnosis is very important to ensure patient management and to avoid complications of delayed care. We present a case who coincidentally was diagnosed with PAD and thus obstructive jaundice.

An uncommon cause of pancreatitis with obstructive jaundice

A 56-year-old man with a history of diabetes mellitus poorly controlled recently (HbA1c: 7.5%, <6%) presented with a 3-month history of postprandial epigastric pain, 10-kg weight loss, steatorrhea, tea-colored urine, and clay-colored stool. Physical examination revealed yellowish skin and icteric sclera but no peripheral stigmata of cirrhosis. Laboratory investigation was significant for elevated aspartate aminotransferase (289 IU/L, 8-31 IU/L), alanine aminotransferase (613 IU/L, 0-41 IU/L), alkaline phosphatase (595 U/L, 34-104 U/L), γ-glutamyl transferase (758 U/L, 0-26 U/L), total and direct bilirubin (8.0/6.1 mg/dL, 0.3-1/0.03-0.18 mg/dL), and carbohydrate antigen 19-9 (289 U/mL, <37 U/mL). Contrast-enhanced computed tomography revealed diffuse enlargement of the pancreas (arrow) and dilatation of the common bile duct (CBD) without identifiable stone or a mass lesion (arrowhead; Figure 1A). Endoscopic ultrasound (EUS) demonstrated hyperechoic foci and strands in the enlarged pancreas (arrow) and layer-by-layer whole wall thickening with a hyper-hypo-hyperechoic series (sandwich pattern) of CBD (arrowhead) as well as gallbladder (star; Figure 1B). Magnetic resonance cholangiopancreatography (MRCP) showed dilated CBD with distal tapering near the pancreatic head (arrow; Figure 1C). The diagnosis of autoimmune pancreatitis was confirmed by serologic immunoglobulin G4 (IgG 4) elevation (IgG 4: 2880 mg/dL, 3-201 mg/dL) and favored type I according to nonductal Level 1/Level 2 criteria of international consensus diagnostic criteria.1 The patient recovered from jaundice and gained weight after treatment of prednisone 40 mg/d for 4 weeks, then taper by 5 mg/wk. The 8-week follow-up EUS demonstrated normalization of pancreatic size (arrow) and CBD morphology (arrowhead; Figure 2).2 Autoimmune pancreatitis mimicking pancreatic cancer is a rare cause of obstructive jaundice with an estimated incidence of 1 per 100 000.3 In summary, we demonstrated a case of autoimmune pancreatitis diagnosed by complement image study and elevating serum IgG 4, which achieved successful medical treatment of obstructive jaundice without further invasive procedures.1 The authors declare no conflict of interest. This report was approved by the Research Ethical Committee of Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (No. CR111-08).

S1674 An Unusual Cause of Septic Shock Secondary to Lemmel Syndrome

Introduction: Lemmel syndrome (LS) is a rare cause of obstructive jaundice occurring in the absence of pancreaticobiliary tumors or choledocolithiasis and commonly caused by periampullary diverticulum (PAD) with an incidence of 1-27%. They are typically asymptomatic and underreported leading to complications in ∼5% of cases. Herein, we report a case of septic shock due to acute cholangitis secondary to Lemmel Syndrome. Case Description/Methods: A 58-year-old male with a medical history significant for hypertension who presented to the ER with right upper quadrant abdominal pain, jaundice, and multiple episodes of nonbloody-nonbilious emesis. On admission, the patient was febrile, tachycardic and hypotensive. Initial laboratory tests are shown in the Table. CT of the abdomen showed cholelithiasis and diffuse gallbladder thickening with no intra or extrahepatic biliary duct dilation. He developed septic shock requiring vasopressors. Blood cultures were positive for Escherichia coli, and antibiotics were administered. Emergent ERCP was performed due to the presence of acute cholangitis. He was found to have a large diverticulum located around the major ampulla. Double wire technique was performed to access the ventral pancreatic duct (VPD) and common bile duct (CBD). Fluoroscopic images revealed biliary tapering in the distal third but no visualized stones (Figure). Plastic stents were placed into the VPD and CBD and biliary sphincterotomy was performed. He also underwent laparoscopic cholecystectomy. The patient was discharged with resolution of symptoms. Discussion: The pathophysiology of LS is due to direct mechanical irritation of the diverticulum causing papillary fibrosis. Secondly, the diverticulum may cause sphincter of Oddi dysfunction. Thirdly, the distal CBD may be directly compressed by the periampullary diverticulum. The imaging modalities of choice to confirm the diagnosis include enhanced contrast CT and MRCP. ERCP allows for direct visualization of the duodenal diverticulum. Treatment of these entities is required if the patient becomes symptomatic. The mainstay of treatment is endoscopic sphincterotomy with stent placement or papillary balloon dilation. Due to the high recurrence rate, if endoscopic treatment fails then surgical approach via diverticulectomy is performed. It is important physicians remain vigilant regarding this condition since misdiagnosis leads to delay in therapy. The incidence of septic shock in LS is unknown and to our knowledge, there has only been one other reported case in literature.Figure 1.: A: Cholangiogram of biliary tree with no stones B: Cholangiogram with diverticulum, stent in place and no obvious stones C: Periampullary diverticulum after placement of CBD and pancreatic stent D: CT abdomen showing CBD stent in place with gallbladder sludge. Table 1. - Initial Laboratory Values Blood Chemistry Reference Range Sodium 137 mmol/L 136 - 145 mmol/L Potassium 3.8 mmol/L 3.5 - 5.3 mmol/L Blood urea nitrogen (BUN) 10.0 mg/dL 6 - 24 mg/dL Creatinine 1.0 mg/dL 0.6 - 1.2 mg/dL Lactic acid 5.3 mmol/L 0 – 2.0 mmol/L C-reactive protein 21.8 mg/dL 0.0-0.8 mg/dL TSH 1.1180 µIU/mL 0.400 - 4.500 µIU/mL Total bilirubin 3.3 mg/dL 0.2–1.2 mg/dL Direct bilirubin 1.94 mg/dL 0.0-0.3 mg/dL AST 487 U/L 10-36 U/L ALT 365 U/L 9-46 U/L Alkaline phosphatase 155 U/L 40-115 U/L Complete blood count White blood cell (WBC) 4.3x10 3/ uL 4.4 - 11 × 103/µL Hemoglobin 12.2 g/dL 13.5 - 17.5 g/dL Platelet 107 x103 /uL 150 - 450 × 103/µL

A rare cause of obstructive jaundice in a patient with hepatocellular carcinoma

A 60-year-old male with known hepatocellular carcinoma (HCC) and hepatitis B, who was taking entecavir and had a history of 10 times transarterial chemoembolization (TACE) procedures, presented with severe abdominal pain to the extent that he could not walk. His-total bilirubin level was 9.30 mg/dL. Enhanced liver phase 3 dynamic computed tomography confirmed extrahepatic biliary obstruction by an intraluminal common bile duct (CBD) mass (marked with a dotted line) with TACE-treated HCC (arrowhead) in the liver (Fig. 1A). On the 23rd day of hospitalization, his liver function further deteriorated that hepatic encephalopathy was developed, and the patient eventually received living donor liver transplantation. Explant showed cirrhotic configuration with CBD obstructed with reddish and bulging intraluminal mass (Fig. 1B).

263 Tuberculosis of the Bile Duct: A Rare Cause of Obstructive Jaundice

Abstract Tuberculosis (TB) is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. A 28-years old woman with obstructive jaundice, who was originally thought to have cholangio-carcinoma. Diagnosis of tuberculosis was made on PCR testing of bile. Patient was started on antitubercular treatment, and she responded well. This case presented a rare case of common bile duct stricture due to biliary tuberculosis. This is an important condition to diagnose because early recognition with prompt treatment results in complete resolution. Even though biliary tuberculosis is a rare cause of obstructive jaundice, in endemic areas, it should be considered as a differential diagnosis and investigated, as it can be potentially curable.

Rhabdomyosarcoma of the common bile duct mimicking choledochal cyst: a rare cause of obstructive jaundice

Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.

S1416 A Not so Simple Case of Obstructive Jaundice

INTRODUCTION: Lemmel syndrome is a rare cause of obstructive jaundice caused by a duodenal diverticulum compressing the intra-pancreatic part of the common bile duct with resultant dilation of the extra-and intrahepatic bile ducts. In our case, we present a patient with suspected Lemmel syndrome after a difficult diagnostic workup, demonstrating the importance of a broad differential when approaching jaundice. CASE DESCRIPTION/METHODS: We present a 50-year-old Caucasian male with a history of EtOH abuse, necrotizing pancreatitis s/p laparoscopic cystogastrostomy, obesity, and cholecystectomy. The patient presented with a four-day history of sharp, epigastric pain associated with nausea, non-bloody vomiting, and lethargy. The patient stated the symptoms were similar to those related to prior episodes of necrotizing pancreatitis and admitted to drinking 16 cans of beer per day for the past four months. Physical examination revealed diffuse jaundice, scleral icterus, and right upper quadrant tenderness. Initial laboratory findings included platelets 86 × 109/L., total bilirubin 13.52 mg/ dL, AST 900 U/L, ALT 266 U/L, ALP 456 U/L and GGT 11180 U/L. Right upper quadrant ultrasound noted patent portal and hepatic veins. Magnetic resonance cholangiopancreatography (MRCP) was performed. It noted a 1.7 cm mildly high T1 lesion medial and contiguous with the second portion of the duodenum, possibly representing a duodenal diverticulum. The common bile duct was dilated with abrupt narrowing/cut off at the level of the second portion of the duodenum. The findings were suggestive of Lemmel syndrome, and to be confirmed by ERCP. DISCUSSION: This case illustrates the importance of maintaining a broad differential diagnosis and also brings awareness to a rare potential etiology of jaundice. The patient's excessive alcohol intake made acute alcoholic hepatitis the most likely initial suspected etiology of the patient’s jaundice. However, the continued elevation of transaminases and hyperbilirubinemia necessitated additional investigative studies. Imaging suggested the rare disorder known as Lemmel syndrome. Lemmel syndrome is caused by a periampullary duodenal diverticulum compressing the intra-pancreatic part of the common bile duct. This disorder should be considered in patients presenting with obstructive jaundice without malignancy or choledocholithiasis. Delayed identification can lead to unnecessary diagnostic testing, recurring symptoms, frequent hospital visits, and an increase in morbidity and mortality.Figure 1.: MRCP Findings.

Congenital biliary web- a rare cause of obstructive jaundice in an infant: A case report

Background: Congenital biliary web of the extra-hepatic biliary tree is becoming exceedingly rare cause of obstructive jaundice in children. Case Presentation: We report a case of 5-month-old male baby who presented with acholic stools and persistent jaundice since birth. Magnetic resonance cholangiopancreatography (MRCP) showed contracted gall bladder and focal narrowing at mid portion of the common bile duct (CBD) with proximal dilatation of biliary channels. On exploration, a complete web was found just proximal to the confluence of cystic duct and common hepatic duct causing complete obstruction of biliary tree. A Roux-en-Y hepatico-jejunostomy was done. Postoperative recovery was uneventful. Conclusion: We conclude that congenital biliary web is a rare entity and should be considered in the dif­ferential diagnosis of biliary atresia.

AB171. Biliary duct tumour thrombosis with hepatocellular carcinoma—a case report

: Jaundice in hepatocellular carcinoma (HCC) is an unusual presentation and may be multifactorial. A rare cause of obstructive jaundice in HCC is biliary metastasis, known as bile duct tumour thrombosis (BDTT). BDTT can be challenging to diagnose but has characteristic histopathological features. There is considerable uncertainty regarding optimal surgical management of BDTT and its contribution to HCC-related morbidity and mortality. We present the case of an eighty-year-old gentleman diagnosed with BDTT. We discuss jaundice in HCC, the diagnosis and management of BDTT and finally provide some learning points for future. The patient initially presented with obstructive jaundice and was diagnosed with both gallstones and fasciola hepatica. After jaundice persisted, an Endoscopic retrograde cholangiopancreatography (ERCP) was undertaken and four separate histopathologists identified hepatocellular tissue in the bile duct samples. No fasciola was proven. A repeat computed tomography (CT) revealed a segment intravenous (IV) HCC and the patient was formally diagnosed with BDTT. He was not considered suitable for a surgical intervention but to his medical comorbidities and age and was managed conservatively before being discharged home. BDTT is rare and can be difficult to diagnose. There was considerable diagnostic uncertainty in our patient until the histology had been reported. BDTT is often associated with vascular invasion, and suspected mechanism of spread likely involves direct tumour extension and haemobilia, leading to poorer outcomes. While surgery is recommended, the role of a thrombectomy is contested, with most surgeons advocating bile duct excision. Obstructive jaundice in the presence a liver lesion should alert clinicians to the possibility of BDTT. Where possible a liver resection and bile duct excision should be attempted as this seems to offer the best outcome. Lastly, further clarity is needed on whether BDTT has an adverse effect on HCC survival and recurrence, and whether or not a bile duct excision is preferable to a thrombectomy.

1314 Lemmel Syndrome in a Centenarian

INTRODUCTION: Obstructive jaundice can be caused by intraluminal forces (choledocholithiasis), extraluminal forces (carcinoma) or transmural forces (choledochal cysts). In addition to the above, a rare cause of obstructive jaundice includes periampullary diverticula - Lemmel's syndrome. This syndrome involves a periampullary duodenal diverticulum that can compress the common bile duct resulting in obstructive jaundice. These diverticula are extraluminal and their prevalence increases with age and given that the majority are asymptomatic, they can be overlooked in imaging studies. It is estimated that 5% of patients experience acute symptomatology due to these diverticula. CASE DESCRIPTION/METHODS: This is the case of an over 90-year-old male with medical history of hypertension and Alzheimer's dementia who came to the ER due to right upper quadrant abdominal pain the day prior to admission. Physical wasexam remarkable for epigastric and right upper quadrant tenderness. Labs with transaminitis (ALT:1294 U/L, AST: 1166 U/L), alkaline phosphatase 366 U/L, total bilirubin 3.2 mg/dL, amylase: 123 U/L, lipase: 98 U/L). Abd/pelvic CT scan reported prominence of the intrahepatic and extrahepatic biliary system. The common bile duct measuring 8-9 mm, proximal pancreatic duct dilated approximately 4 mm, and the common bile duct extending to a large duodenal diverticulum without evidence of choledocholithiasis. Considering the patients advanced age, he was treated with conservative medical management including antibiotic therapy. DISCUSSION: This case highlights the importance of taking a holistic approach to patient care especially patients of advanced age who may have findings suggestive of a diagnosis that is overlooked as it is uncommon. The literature states that the detection rate of duodenal diverticula ranges from 1% to 27%. In addition, the majority of peri-ampullar diverticula are asymptomatic however 5% of cases can present with bleeding, jaundice or intestinal obstruction. Misdiagnosis of this condition may lead to erroneous management and delay in treatment in patients who are able to receive aggressive management.

Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis.

One of the evolutionary complications of hepatic echinococcosis (HE) is cholangiohydatidosis, a rare cause of obstructive jaundice and cholangitis. The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM). Case series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bilirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated. A total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%. Cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality.

Embryonal rhabdomyosarcoma of the biliary tree in a paediatric patient - A rare cause of obstructive jaundice.

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in the paediatric age group, ranking fourth in frequency after central nervous system tumours, neuroblastomas and nephroblastomas. Embryonal RMS of the biliary tree is considered a rare entity, with the most common clinical presentation being that of obstructive jaundice. We present the case of a 4-year-old boy who presented with hepatomegaly and obstructive jaundice. Biochemically, there was evidence of elevated ductal enzymes with conjugated hyperbilirubinaemia. The magnetic resonance imaging (MRI) features were consistent with a biliary RMS with the differential diagnosis of a choledochal cyst initially included based on the computed tomography images. The diagnosis of embryonal biliary RMS was later confirmed on histology. This case illustrates the importance of considering malignant aetiologies in paediatric cases of obstructive jaundice, as this entity is infrequently described in the literature and may mimic the appearance of a choledochal cyst. The demonstration of enhancement of intraductal material within the biliary tree on MRI and the presence of arterial waveforms within the intraductal mass on ultrasound assists in the differentiation between biliary RMS and a choledochal cyst.

A rare cause of obstructive jaundice: diagnosis by EUS and single-operator per-oral cholangioscopy.

A rare cause of obstructive jaundice: diagnosis by EUS and single-operator per-oral cholangioscopy.

A rare cause of obstructive jaundice - case report

A rare cause of obstructive jaundice - case report

Diffuse Large B Cell Lymphoma Presenting With Obstructive Jaundice

Diffuse Large B cell Lymphoma (DLBCL) is the most common histologic subtype of non-Hodgkin's lymphoma(NHL). Although jaundice occurs in a fair number of patients with lymphoma, it is rarely seen as a presenting complaint. We present a case of DLBCL presenting with biliary obstruction.Figure: ERCP showing dilated right, left hepatic ducts and common hepatic duct. There is narrowing of common bile duct.Figure: CT scan of the abdomen/pelvis showing a new intrahepatic and extrahepatic biliary ductal dilatation.A 62 year old male presented to the emergency room with jaundice and was found to have a total bilirubin of 13.2 and a direct bilirubin of 8.1. CT abdomen and pelvis showed new intra hepatic and extra hepatic biliary ductal dilatation, new extensive lymphadenopathy within the lower chest and upper abdomen. The patient underwent ERCP which showed a biliary stricture due to compressive lymphadenopathy. A retrievable plastic stent was placed after endoscopic balloon dilation. Patient was also noted to have extensive inguinal lymphadenopathy. A right inguinal lymph node biopsy favored a diagnosis of diffuse large B cell lymphoma. He was started only on rituximab and prednisone chemotherapy initially. After biliary stent placement, total bilirubin reduced to 4 and direct bilirubin to 1.7. Doxorubicin based chemotherapy was delayed until total bilirubin was 4, due to its excretion through bile. R-CHOP chemotherapy regimen was started at this time. A follow up PET scan in three months showed interval improvement in the lymphadenopathy and the biliary stent was removed. There is a paucity of treatment guidelines due to infrequent initial presentation of DLBCL with jaundice. Role of biliary stent placement is controversial as it provides relief of obstruction and symptoms but does not cure underlying disease. Our case highlights excellent response of DLBCL with sequencing and dosing of chemotherapeutic agents preceded by biliary drainage. Jaundice in patients with lymphoma can be due to direct hepatic/biliary involvement, extra hepatic bile duct obstructions, toxic hepatitis due to drug treatment or tumor related hemolysis. Although a rare cause of obstructive jaundice, NHL should be considered in the differential diagnosis.

A rare cause of obstructive jaundice - VHL syndrome

A rare cause of obstructive jaundice - VHL syndrome

Embryonal rhabdomyosarcoma of the biliary tree: A rare cause of obstructive jaundice in children which can mimic choledochal cysts.

Jaundice in children is more often due to hepatic disease than obstruction. Differential considerations for obstructive jaundice in children include choledocholithiasis, choledochal cysts and rare neoplasms. Rhabdomyosarcoma, the most common soft tissue sarcoma in pediatric patients, typically involves the head and neck, genitourinary system and extremities. Embryonal rhabdomyosarcoma of the biliary tree is a rare entity. We present a 3-year-old boy with abrupt onset obstructive jaundice. Although initial imaging suggested a dilated biliary system with fusiform common bile duct, sludge, and possible cholelithiasis, endoscopic retrograde cholangiopancreatogram (ERCP) diagnosed a common bile duct embryonal rhabdomyosarcoma and further imaging showed involvement of the cystic duct. This case illustrates the importance of considering malignant etiologies in cases of obstructive jaundice, particularly when imaging is not classic for common causes.

Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis

BackgroundOne of the evolutionary complications of hepatic echinococcosis (HE) is cholangiohydatidosis, a rare cause of obstructive jaundice and cholangitis. The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM). Material and methodCase series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bi-lirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated. ResultsA total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%. ConclusionCholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality.